Ezetimibe plus simvastatin reduces the risk of major cardiovascular events by 6 per cent more than simvastatin monotherapy, according to findings presented at the American Heart Association scientific sessions. Researchers enrolled 18,144 patients from 39 countries with recent acute coronary syndrome who received ezetimibe (10mg) plus simvastatin (40mg) or simvastatin monotherapy (40mg). After a median follow-up of six years, the primary endpoint (which was a composite of cardiovascular death, myocardial infarction [MI], unstable angina and coronary revascularisation after 30 days and stroke) was some 6 per cent lower with ezetimibe plus simvastatin (32.7 per cent) than simvastatin (34.7 per cent). The number needed to treat to prevent one event was 50.

The combination, compared to simvastatin monotherapy, significantly reduced the risk of MI (13.1 versus 14.8 per cent), stroke (4.2 versus 4.8 per cent), ischemic stroke (3.4 versus 4.1 per cent) and the composite of CV death, MI and stroke (20.4 versus 22.2 per cent). No significant differences emerged for all-cause or cardiovascular mortality or the need for coronary revascularisation. MSD now plans to apply to the European Medicines Agency for a new indication for reduction of major cardiovascular events.