Stroke recurrence lower with ezetimibe–atorvastatin combo vs atorvastatin alone

Combination therapy with ezetimibe plus atorvastatin appears to better protect against ischaemic stroke recurrence compared with atorvastatin monotherapy, according to a study.

Researchers used data from the Korean Health Insurance Review and Assessment database and conducted a dual-design study integrating both cohort and case–control study designs. For the cohort study, the risk of ischaemic stroke recurrence was compared between ezetimibe users and nonusers. Then, propensity-score matching within the atorvastatin and rosuvastatin groups was performed based on age, sex, index year, comorbidities, and medications at baseline.

The cohort study included 26,937 patients with a history of ischaemic stroke, among whom 16,215 were in the atorvastatin group and 10,722 were in the rosuvastatin group. The propensity-score matched cohort comprised 2,180 pairs of ezetimibe users and nonusers in the atorvastatin group and 4,024 pairs in the rosuvastatin group. Among ezetimibe users, the average daily doses were 28.8 mg for atorvastatin and 14.2 mg for rosuvastatin, whereas among nonusers, the doses were 30.5 mg and 15.1 mg, respectively.

Within the atorvastatin group, the incidence rate of stroke recurrence was lower among ezetimibe users vs nonusers (18.47 vs 24.66 per 1,000 person-years; adjusted hazard ratio [aHR], 0.73, 95 percent confidence interval [CI], 0.55–0.98; p=0.037).

On the other hand, within the rosuvastatin group, the incidence rate of stroke recurrence did not significantly differ between ezetimibe users and nonusers (21.50 vs 21.63 per 1,000 person-years, respectively; aHR, 1.00, 95 percent CI, 0.80–1.24; p=0.985).

Among ezetimibe nonusers, the incidence of stroke recurrence was also similar between the atorvastatin and rosuvastatin monotherapy groups (aHR, 0.81, 95 percent CI, 0.63–1.03; p=0.1).

Interaction analysis suggested a potential protective benefit with ezetimibe when combined with atorvastatin (ezetimibe × statin type: aHR, 0.72, 95 percent CI, 0.50–0.93; p=0.047).