CONCLUSIONS The results suggested that ezetimibe add-on to statin therapy is associated with an enhanced TNF-α-lowering effect  compared with statin monotherapy .
AIMS Statins are known to influence the status of adipokines , which play a key role in the pathophysiology of cardiometabolic diseases .
As the effect of ezetimibe as an add-on to statin therapy on the impact of statins on plasma adipokines levels is currently unclear , the aim of the present study was to investigate this through a meta- analysis of controlled trials .
Achievement of Dual Low-Density Lipoprotein Cholesterol and High-Sensitivity C-Reactive Protein Targets More Frequent With the Addition of Ezetimibe to Simvastatin and Associated With Better Outcomes in IMPROVE-IT
Background — Statins lower low-density lipoprotein cholesterol ( LDL-C ) and high-sensitivity C-reactive protein ( hs-CRP ) ; addition of ezetimibe to statins further reduces LDL-C and hs-CRP . An analysis of the relationship between achieved LDL-C and hs-CRP targets and outcomes for simvastatin and ezetimibe/simvastatin was prespecified in Improved Reduction of Outcomes : Vytorin Efficacy International Trial ( IMPROVE-IT ) . Methods and Results — The IMPROVE-IT trial r and omly assigned 18 144 patients stabilized after acute coronary syndrome to simvastatin or ezetimibe/simvastatin .  LDL-C and hs-CRP were measured at baseline and 1 month after r and omization . Outcomes were assessed in those achieving one or both of the prespecified targets of LDL-C<70 mg/dL and hs-CRP<2 mg/L versus achieving neither target , adjusting for differences in baseline characteristics . An exploratory analysis examined targets of LDL-C<50 mg/dL and hs-CRP<1 mg/L. Patients meeting both targets at baseline , with no 1-month values , or with end points before 1 month were excluded . Of 15 179 patients , 39 % achieved the dual LDL-C ( < 70 mg/dL ) and hs-CRP ( < 2 mg/L ) targets at 1 month , 14 % met neither target , 14 % met only the hs-CRP target , and 33 % met only the LDL-C target . Those achieving dual targets had lower primary end point rates than those meeting neither target ( cardiovascular death , major coronary event , or stroke ; 38.9 % versus 28.0 % ; adjusted hazard ratio , 0.73 ; 0.66–0.81 ; P<0.001 ) . More patients treated with ezetimibe/simvastatin  met dual targets than those treated with simvastatin alone ( 50 % versus 29 % , P<0.001 ) . The association of dual-target attainment with improved outcomes was similar irrespective of treatment assignment ( P-interaction=0.65 ) . Similar findings were observed using the exploratory targets . Conclusions — Significantly more patients treated with ezetimibe/simvastatin  met prespecified and exploratory dual LDL-C and hs-CRP targets than patients treated with simvastatin alone . Reaching both LDL-C and hs-CRP targets was associated with improved outcomes after multivariable adjustment . Clinical Trial Registration — URL : http://www . clinical trials.gov ; Unique identifier : NCT00202878
CONCLUSIONS The results suggested that ezetimibe add-on to statin therapy is associated with an enhanced TNF-α-lowering effect  compared with statin monotherapy .
AIMS Statins are known to influence the status of adipokines , which play a key role in the pathophysiology of cardiometabolic diseases .
As the effect of ezetimibe as an add-on to statin therapy on the impact of statins on plasma adipokines levels is currently unclear , the aim of the present study was to investigate this through a meta- analysis of controlled trials .