Key result
Guideline-based treatment intensification with statin and ezetimibe strategies was estimated to reduce MACE by 5.4% to 6.4% relative to business-as-usual over 5 years.
Why the study?
The 2019 ESC/EAS guidelines recommend risk-based LDL-C goals, but the impact of adopting treatment intensification strategies with statins, ezetimibe, or their fixed-dose combination on LDL-C goal achievement and MACE across multiple countries was unquantified.
Does treatment intensification with statin and ezetimibe (separate or fixed-dose combination) reduce MACE compared to status quo in a simulated population?
Does treatment intensification with statin and ezetimibe (separate or fixed-dose combination) reduce MACE compared to status quo in a simulated population?
Effect estimate: Relative reduction 5.4% and 6.4%
Simulation modeling suggests that adopting 2019 ESC/EAS guidelines with statin and ezetimibe, especially as fixed-dose combinations, could avert millions of MACE events globally over 5 years.
Modeling projects MACE reductions with statin-ezetimibe intensification; leaves open real-world confirmation before practice change.
AIMS: The 2019 European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) dyslipidaemia guidelines recommend achievement of low-density lipoprotein cholestrol (LDL-C) goals based on an individual's risk. We aimed to evaluate the impact of guideline adoption with statin, ezetimibe, and statin plus ezetimibe fixed-dose combination (FDC) on LDL-C goal achievement and incidence of major adverse cardiovascular events (MACE) across six countries. METHODS AND RESULTS: A simulation model with a five-year horizon (2020-2024) was developed based on Institute for Health Metrics and Evaluation Global Burden of Disease Study database with a business-as-usual (BAU) scenario representing status quo, intervention scenario-1 representing treatment with statin and ezetimibe as separate agents, and intervention scenario-2 representing treatment with statin or statin plus ezetimibe FDC. MACE was defined as the composite of myocardial infarction, ischaemic stroke, and cardiovascular death. The mean population LDL-C was reduced from 4.25 mmol/L in the BAU scenario, to 3.65 mmol/L and 3.59 mmol/L in intervention scenarios-1 and -2, respectively. Compared with BAU, intervention scenarios-1 and-2 resulted in relative reduction of MACE by 5.4% and 6.4% representing ∼3.7 and 4.4 million MACE averted, respectively, across six countries over 5 years. The absolute benefit in terms of MACE averted was highest for China, whereas France had highest relative reduction in MACE with both intervention scenarios compared with BAU. CONCLUSION: The 2019 ESC/EAS guideline-based treatment intensification with strategies based on statin, ezetimibe, and statin plus ezetimibe FDC is estimated to result in a substantial population-level benefit in terms of MACE averted compared with BAU.
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Farnier et al. (2022) studied Dyslipidaemia. Statin, ezetimibe, and statin plus ezetimibe fixed-dose combination vs. Business-as-usual (BAU) scenario was evaluated on Composite of myocardial infarction, ischaemic stroke, and cardiovascular death (MACE) (Relative reduction 5.4% and 6.4%). Guideline-based treatment intensification with statin and ezetimibe strategies was estimated to reduce MACE by 5.4% to 6.4% relative to business-as-usual over 5 years.
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