Ezetimibe + Statin: RACING Study w/ Dr. Chris Cannon (E11)
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- Опубліковано 24 лис 2022
- Ezetimibe in addition to a moderate intensity vs a high dose statin in ASCVD patients - the RACING trial
So, this trial might appear a bit boring and maybe not so relevant - but maybe only at first. What might add to the difficulty reading or interpreting it is the non-inferiority design - and we might to a methods primer on that in the future. However, this trial may be the answer for a very important question: what do we do with patients who are intolerant to higher doses of statins - can a statin-sparing regimen be the answer?
This was a randomized controlled trial of a high-intensity statin, rosuvastatin 20mg daily vs a moderate-intensity statin - 10mg of rosuvastatin daily - plus 10mg of ezetimibe or Zetia. The trial recruited 3,780 patients with atherosclerotic cardiovascular disease and followed them for three years. The primary endpoint was the composite of cardiovascular death, major adverse cardiovascular events, or non-fatal stroke, and was reached in 9.9% in the high-intensity statin group vs 9.1% in the combination group.
Our guest is Christopher P. Cannon, M.D.. He is a cardiologist at Brigham and Women’s Hospital in Boston and a professor at Harvard Medical School. He has run major trials of statins and other interventions to prevent major adverse cardiovascular (and cerebrovascular) events, including the IMPROVE-IT study.
Here are Ben's personal take-aways from this fascinating conversation:
1. 10mg rosuvastatin + 10mg ezetimibe is as effective as 20mg of rosuvastatin in preventing MACCE in ASCVD patients
2. ezetimibe is an add-on option when the statin dose has to be lowered, eg in patients
--with statin-related side effects
--at risk for diabetes (eg, "pre-diabetes")
3. lowering LDL is proportional to reducing the MACCE risk
4. ezetimibe is anti-inflammatory
References:
-RACING Study: BK Kim et al.: Long-term efficacy and safety of moderate-intensity statin with ezetimibe combination therapy versus high-intensity statin monotherapy in patients with atherosclerotic cardiovascular disease (RACING): a randomised, open-label, non-inferiority trial. Lancet. 2022 Jul 30;400(10349):380-90. pubmed.ncbi.nlm.nih.gov/35863...
-IMPROVE-IT: CP Canon et al.: Ezetimibe Added to Statin Therapy after Acute Coronary Syndromes. N Engl J Med . 2015 Jun 18;372(25):2387-97. pubmed.ncbi.nlm.nih.gov/26039...
-DI Swerdlow et al.: HMG-coenzyme A reductase inhibition, type 2 diabetes, and bodyweight: evidence from genetic analysis and randomised trials. Lancet 2015; 385: 351-61. pubmed.ncbi.nlm.nih.gov/25262...
-SU Khan et al.: Association of Lowering Low-Density Lipoprotein Cholesterol With Contemporary Lipid-Lowering Therapies and Risk of Diabetes Mellitus: A Systematic Review and Meta-Analysis. J Am Heart Assoc. 2019;8:e011581. pubmed.ncbi.nlm.nih.gov/30898...
-MG Silverman et al.: Association Between Lowering LDL-C and Cardiovascular Risk Reduction Among Different Therapeutic Interventions. A Systematic Review and Meta-analysis. JAMA. 2016;316(12):1289-97. pubmed.ncbi.nlm.nih.gov/27673...
-PM Ridker et al.: Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease. N Engl J Med. 2017;377(12):1119-1131. pubmed.ncbi.nlm.nih.gov/28845...
-Y Ouchi et al.: Ezetimibe Lipid-Lowering Trial on Prevention of Atherosclerotic Cardiovascular Disease in 75 or Older (EWTOPIA 75): A Randomized, Controlled Trial. Circulation. 2019.140(12):992-1003. pubmed.ncbi.nlm.nih.gov/31434...
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Cholesterol increases every time the body encounters inflammation or infection. It’s a protective reaction of the body.
Lets not forget the failed ENHANCE trial where a statin plus ezetimibe grew more artery plaque than the statin alone.
Ezetimibe almost killed me. Rashes, red nose and face, bloodvessels burst in nose, sinus, horrible headaches, extreme exhaustion, could hardly breathe. Stopped it and slowly all symptoms left.
Improve-it was submitted for FDA approval and was rejected based on a tipping point analysis as 35% of the participants dropped out and the researchers presented an estimated event rate in place of the missing data of approximately 6 percent- the problem was that the actual event rate was closer to 13% and when substituted for the estimate proved to show a relative risk opposite of what was presented- worse off
I thank Crestor and zetia been doing it since 2011 ,13 years. My ldl went from 190 to 50. I had a metabolic panel , blood test every 4 months.
Then in 2014 had to stop zetia , and in 2016 my doctor told me I had developed an allergic reaction to Crestor had to stop something about my muscles , I was peeing black . Then in 2018 I tole my dr. To put me back on Crestor and Zetia the dosage being 20 and 10 as he found blockage in my right leg, fingered I could tolerate these drugs for a month or so while we explored the newer injectable stuff. In 2022 I cut my Crestor dose to 10 mg , with my dr approval , still taking zetia everything was good. Then in late in 2023 I was having a lot of muscle pain and one of my muscle enzyme was elevated so we decided to stop Crestor only , my ldl went up to 162 2 months later I started Crestor again 10 mg with zetia ldl went to 70 my muscle pain gone I hope that is a clear account
My friend developed rhabdomyolysis: extreme muscle pain and loss from Crestor. I wouldn’t get back on it if I were you. She has been on a walker and a cane now, almost a year.
Interesting!
Glad you think so!
Dangerous
Have u done study with people who on statin + plant base and IF ? Bec that is just as effective in lowering cholesterol and triglycerides
Ezetimibe caused me to have extreme Achilles tendinitis. It started when my doctor added it to my statin and stopped when I quit taking it.
Thanks for your comment and sorry to hear about this. Tendinitis may be an underrecognized side effect
@@BenGeisler it effected other tendons to just not to the degree as the Achilles. That was down right debilitating. My pharmacist is the one who told me it was probably the ezetimibe.
Yes, there are case reports in the literature but it's not known very widely, I believe
20/10 Rosuvastatin and Ezetimib, i have high cholesterol and high BP all my life, i have no problem with this Medication
@@nenadcubric2663 glad to hear. I got off of it for a month, tendinitis went away. Got back on it and the tendinitis started coming back.
When u stay u have study a group of people this certainly means its during your prescription of drugs to your actual patients and put them int he records and report to pharmaceutical company right ?
Zedia on its own dropped my ApoB 41% with zero side effects. A very small dose of a statin stops the rebound effect over time , but higher doses of statin is problematic.
Do you want more cards journal clubs?
It works well for me
Very vague
You are
I have to take these cause of cholesterol and triglycerides over 300. I've been doing healthy keto and fasting for over 2 years and still can't get it down. Its in the genes.
'healthy keto' seems to be an oxymoron, unfortunately. Marketing hype is one thing but the actual science is often something else again.
Statins cause muscle pain, muscle loss, cognitive decline, diabetes, depletion of coq10, depletion of k2. Cholesterol is protective, cholesterol does not cause heart disease. I ❤ cholesterol.
You are right about the side effects but cholesterol kills.
@@chicagomike no it does not. Cholesterol keeps our muscle strong, our brain healthy, creates vitamin d , keeps the membranes of our cells intact. Cholesterol will lay calcium to repair damaged arteries . People with low cholesterol have high risk of all cause death , epidemiology studies say.
a question 20mg or prevastatin and 10mg of ezetamibe does it cause blisters?
What's closest to 10mg rosuva? 5mg rosuva + how much ezetimibe?
10 ,zedia 10mg and 2.5mg - 5mg of statin. And dropping apoB is the most important thing.
May i ask the meaning of RACING ?
It's the acronym of the trial
@@BenGeisler in details if possible ❤️
@@nouraabdullah02 "randomised comparison of efficacy and safety of lipid lowering with statin monotherapy versus statin-ezetimibe combination for high-risk cardiovascular disease" - see link in the description
Oxymoron statement "Treating Cholesterol" a substance we cannot live without.
Certainly true - where was that statement?
Yes, we cannot live without it, no one doubts that, but not when it is skyrocketing in your blood because of bad genes, more of it doesn’t mean you get healthier!!!
Kind of like, “treating glucose,” or “treating blood pressure.”
The 1% drop in heart attack risk isn't worth the side effects. If you want to drop cholesterol safely take 600mg of EDTA daily at night followed with a good multivitamin
It’s a 25% drop in heart attacks. Still to many side effects like 40-50% chance if your an older female of new onset diabetes.
@@nancyevans5176 Absolute Risk Reductions would be around 1.5 %
Statins increase your risk of diabetes by approximately 50 percent, a verry high price to pay
thats not true
Post your effing source
Lowering healthy LDL actually kills the patient. Really bad advice.
Which study are you referencing?
What is a healthy LDL level?
Another lying cardiologist!!
Post some studies.
@@dr.emilschaffhausen4683 Ah, the good old drug company funded studies
They never say if tolerated. They just say shut up and keep taking your meds. Walgreens called and asked if I was tolerating Ezetimibe. You'd think doctors and their nurses would do a follow-up on a new med. And yes I'm alot more sore since adding Ezetimibe to my statins. Especially walking has gotten worse with heavier legs.
@@tbunnewith I'm on both too, but going to ask cardio about weening myself off. I've lost weight and excercise regularly. Problem is I've had an event in the past.
Statines prevent Strokes and Heart Attack!