Comparative efficacy of different statin intensities combined with ezetimibe on lipid profile improvement in patients with coronary heart disease: A network meta-analysis.
Source: PubMed, NCBI / U.S. National Library of Medicine
Despite statin medication, a substantial number of patients with coronary heart disease (CHD) do not meet guideline-recommended lipid goals, increasing dependence on combination lipid-lowering methods. However, evidence comparing the lipid-modifying effectiveness of ezetimibe added to statins of varying intensities is lacking, creating confusion about the best treatment options in clinical practice. This research sought to assess and compare the effectiveness of statins of varying intensities in conjunction with ezetimibe for enhancing lipid profiles in individuals with CHD. PubMed, Embase, Cochrane Library, and Web of Science were searched to January 1, 2026 for randomized controlled trials (RCTs) comparing statin monotherapy with statin-ezetimibe therapy in CHD. Network meta-analysis was performed using Stata 17.0, with surface under the cumulative ranking curve-based ranking. Outcomes were low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), total cholesterol (TC), non-HDL-C, and apolipoprotein B (ApoB). A total of 38 RCTs involving 7340 patients with CHD were included. Network meta-analyses demonstrated that moderate-intensity statin (MIS) therapy coupled with ezetimibe regularly resulted in significant enhancements in LDL-C, HDL-C, TC, non-HDL-C, and ApoB levels. For LDL-C reduction, MIS plus ezetimibe was comparable in efficacy to a high-intensity statin (HIS) plus ezetimibe. For TG, HIS combined with ezetimibe w
Abstract
Despite statin medication, a substantial number of patients with coronary heart disease (CHD) do not meet guideline-recommended lipid goals, increasing dependence on combination lipid-lowering methods. However, evidence comparing the lipid-modifying effectiveness of ezetimibe added to statins of varying intensities is lacking, creating confusion about the best treatment options in clinical practice. This research sought to assess and compare the effectiveness of statins of varying intensities in conjunction with ezetimibe for enhancing lipid profiles in individuals with CHD. PubMed, Embase, Cochrane Library, and Web of Science were searched to January 1, 2026 for randomized controlled trials (RCTs) comparing statin monotherapy with statin-ezetimibe therapy in CHD. Network meta-analysis was performed using Stata 17.0, with surface under the cumulative ranking curve-based ranking. Outcomes were low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), total cholesterol (TC), non-HDL-C, and apolipoprotein B (ApoB). A total of 38 RCTs involving 7340 patients with CHD were included. Network meta-analyses demonstrated that moderate-intensity statin (MIS) therapy coupled with ezetimibe regularly resulted in significant enhancements in LDL-C, HDL-C, TC, non-HDL-C, and ApoB levels. For LDL-C reduction, MIS plus ezetimibe was comparable in efficacy to a high-intensity statin (HIS) plus ezetimibe. For TG, HIS combined with ezetimibe was rated highest, while no significant change was noted in comparison to MIS combined with ezetimibe. Rosuvastatin plus ezetimibe may demonstrate the greatest efficacy among MIS-based combination regimens. Adding ezetimibe to MIS medication in patients with CHD provides a more balanced cholesterol-lowering strategy than statin dosage increase alone, with effectiveness equivalent to HIS-based treatment across several lipid measures.