BACKGROUND Evidence supports that more aggressive low-density lipoprotein cholesterol (LDL-C) lowering improves outcomes in patients at high cardiovascular risk, but whether one therapeutic strategy is superior to another remains unclear.

OBJECTIVE This study compared the effectiveness of moderate-intensity statin therapy combined with ezetimibe vs high-intensity statin monotherapy.

METHODS We conducted a retrospective observational cohort study at a large tertiary university hospital. The study included patients prescribed either moderate-intensity statin with ezetimibe or high-intensity statin between January 1, 2018, and December 31, 2020. Propensity score matching was performed to balance clinical characteristics between the groups. The primary endpoint was an ischemic outcome, defined as a composite of cardiovascular death, non-fatal myocardial infarction, and ischemic stroke. Secondary outcomes included cardiovascular death, myocardial infarction, ischemic stroke, revascularization, and all-cause mortality.

RESULTS Before matching, 1380 patients were prescribed moderate-intensity statin-ezetimibe combination therapy, and 1105 patients were prescribed high-intensity statin therapy. After matching, 971 patients were included in each group. Over a median follow-up of 3.8 years, the primary endpoint occurred in 1.7% of patients in the moderate-intensity statin with ezetimibe group and in 2.1% of patients in the high-intensity statin group. The incidence of major adverse cardiovascular events did not differ significantly between the 2 groups (hazard ratio 0.82, 95% CI: 0.41-1.61, P = .558). No statistically significant differences were observed in secondary outcomes, including cardiovascular death, myocardial infarction, ischemic stroke, revascularization, and all-cause mortality.

CONCLUSION In this retrospective cohort study, moderate-intensity statin combined with ezetimibe was as effective as high-intensity statin monotherapy in preventing cardiovascular events.