A double-blind, randomized trial involving 18,144 patients hospitalized for an acute coronary syndrome found that add ezetimibe to statin therapy resulted in incremental lowering of LDL cholesterol (LDL-C) levels and improved cardiovascular outcomes. Moreover, lowering LDL-C to levels below previous targets provided additional benefit. The combination of simvastatin (40 mg) and ezetimibe (10 mg) was compared with simvastatin (40 mg) and placebo. The median follow-up was 6 years. The median time-weighted average LDL-C level during the study was 53.7 mg per deciliter (1.4 mmol per liter) in the simvastatin–ezetimibe group, as compared with 69.5 mg per deciliter (1.8 mmol per liter) in the simvastatin-monotherapy group. The Kaplan–Meier event rate for the primary end point at 7 years was 32.7% in the simvastatin–ezetimibe group, as compared with 34.7% in the simvastatin-monotherapy group. It is in line with a meta-analysis that, on average, a reduction of 1 mmol per liter (38.7 mg per deciliter) in LDL-C levels yields a consistent 23% reduction in the risk of major coronary events over 5 years, suggests that all reductions in LDL levels, regardless of mechanism, are of equivalent benefit. Rates of prespecified muscle, gallbladder, and hepatic adverse effects and cancer were similar in the two groups. This is the first clinical trial to show a benefit of adding a nonstatin lipid-modifying agent to statin therapy. Ezetimibe reduces intestinal cholesterol absorption. Source: http://www.nejm.org/; http://www.thelancet.com/一项包括18,144名因急性冠脉综合征而住院患者的双盲，随机试验发现，他汀类药物加上依泽替米贝治疗所致低密度脂蛋白胆固醇（LDL-C）水平的降低更显著并改善心血管预后。此外，降低LDL-C至先前的目标水平以下更好。辛伐他汀（40毫克）和依泽替米贝（10毫克）的组合与辛伐他汀（40毫克）和安慰剂进行了比较。中位随访时间为6年。研究期间辛伐他汀 – 依泽替米贝组的中位时间加权的LDL-C平均值为每分升53.7毫克（每升1.4毫摩尔），相比之下辛伐他汀单药治疗组为每分升69.5毫克（每升1.8毫摩尔）。辛伐他汀 -依泽替米贝组7年时Kaplan-Meie主要事件发生率为32.7％，相比之下辛伐他汀单药治疗组为34.7％。这与一个荟萃分析认为，平均而言，1毫摩尔每升（每分升38.7毫克）的LDL-C水平下降导致5年间主要冠脉事件的风险减少23％一致，提示所有的LDL-C水平降低，无论机制，均有相当的益处。预先规定的肌肉，胆囊和肝脏的不良反应和癌症发生率两组相似。这是第一个临床试验表明他汀类药物加入非他汀类降脂药治疗有益。依泽替米贝减少肠道胆固醇吸收。来源：http://www.nejm.org/; http://www.thelancet.com/
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