Combination therapy with moderate-intensity statins and ezetimibe and risk of incident PCI/CABG in atherosclerotic cardiovascular disease: a propensity-matched cohort study

Background Combination therapy with moderate-intensity statins and ezetimibe has demonstrated advantages over high-intensity statin monotherapy for several cardiovascular outcomes. However, its effect on the risk of incident percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) remains unclear. This study aimed to compare the risk of PCI/CABG between combination therapy and high-intensity statin monotherapy among patients with atherosclerotic cardiovascular disease (ASCVD) initially receiving moderate-intensity statin therapy. Methods Patients with ASCVD receiving moderate-intensity statin therapy between 2014 and 2023 were identified from the Clinical Data Analysis and Reporting System in Hong Kong. Propensity score matching was used to balance baseline characteristics between groups. Cox proportional hazards regression was used to evaluate the association between the combination therapy versus high-intensity statin monotherapy and incident PCI/CABG. Findings After propensity score matching, 1,452 patients receiving the combination therapy and 5,808 patients with the high-intensity statin monotherapy were included. Compared with the high-intensity statin monotherapy, the combination therapy was associated with a significantly lower risk of PCI/CABG (HR: 0.57, 95% CI: 0.36, 0.91). Additionally, those switching to combination therapy had a greater reduction in LDL-C level (absolute change between groups: −0.29 mmol/L, 95% CI: −0.40, −0.19; relative change between groups: −10.6%, 95% CI: −14.1%, −7.2%). Interpretation Clinicians may consider the initiation of combination therapy to personalize treatment strategies and improve cardiovascular outcomes. Funding No funding has been provided for this research.