Physicians' Academy for Cardiovascular Education

Cholesterol absorption inhibitor plus statin as secondary prevention protects against ischemic stroke

Prevention of Stroke with the Addition of Ezetimibe to Statin Therapy in Patients with Acute Coronary Syndrome in IMPROVE-IT

Literature - Bohula EA, Wiviott SD, Giugliano RP, et al. - Circulation 2017; published online ahead of print


It has been shown that lipid lowering therapy with statins results in a 22% reduction in major vascular events per 1 mmol/L reduction in LDL-C, including a 21% RRR in ischemic stroke per 1 mmol/L reduction in LDL-C [1]. In the IMPROVE-IT study, the addition of the non-statin lipid-lowering drug ezetimibe on top of simvastatin, in the long-term treatment of stabilized post-ACS patients, led to a significant reduction in CV events [2,3].

In this posthoc analysis of the multi-national, double-blind, placebo-controlled IMPROVE-IT study, the incidence and predictors of stroke post-ACS were evaluated. Furthermore, the efficacy of ezetimibe on top of simvastatin was evaluated for the prevention of stroke and other CV events, particularly in patients with a history of prior stroke. Of the 18144 post-ACS patients, 3.5% experienced at least one stroke during a median follow-up of 6 years. 89% were first events and 11% were recurrent events. Out of the first strokes, 82% were ischemic and 16% were hemorrhagic, whereas 2% were of unknown type, and 15% were fatal.

Main results


In the IMPROVE-IT study, the addition of ezetimibe to simvastatin in stabilized post-ACS patients reduced the frequency of ischemic stroke, particularly in patients with a history of prior stroke. These data support the addition of ezetimibe to a moderate-high intensity statin regimen for the prevention of ischemic stroke in stabilized post-ACS patients, particularly if they had a history of stroke prior to their ACS event.


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Find this article online at Circulation

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