efficacy of ezetimibe/simvastatin (10/10 mg) versus high dose statin in dyslipidemia patients: a meta-analysis of randomized controlled trials

Background: the monotherapies of statin and ezetimibe had not successfully achieved their objectives in the management of lipid levels of dyslipidemia patients. we aimed to compare the effects of combined low-dose simvastatin and ezetimibe versus high-dose statin on the lipid-lowering treatment of dyslipidemia patients. methods: we searched five databases published before may 2018, namely pubmed, embase, cochrane, web of science, and clinicaltrials.gov. completely published randomized controlled trials (rcts) comparing the effect of high-dose statin (s) with ezetimibe/simvastatin (10/10 mg; e/s) on the management of dyslipidemia patients were included. results: a total of ten rcts met the inclusion criteria, including 1,624 patients (e/s:691, s:933). six out-comes underwent pooled analysis, including weighted mean difference (wmd) from baseline in total choles-terol (tc), low-density lipoprotein cholesterol (ldl-c), high-density lipoprotein cholesterol (hdl-c), high sensitivity c-reactive protein (hs-crp), triglyceride (tg), and non-high-density lipoprotein cholesterol (non-hdl-c). no significant gap was found between high-dose statin and ezetimibe/simvastatin (10/10 mg) in ldl-c (-1.55; 95% confidence interval [ci]:-4.42~1.31, p=0 .29), hdl-c (1.05; 95%ci:-0.21~2.3, p=0 .1), tg (4.03; 95%ci:-4.53~12.58, p=0.36), and hs-crp (0.14; 95%ci:-0.50~0.78, p=0.67). however, there was significant difference found between the two lipid-lowering treatments in tc (-0.45; 95%ci:-9.07~-0.83, p=0.02) and non-hdl-c (-4.97; 95%ci -8.46~-1.49, p=0.005). conclusion: ezetimibe co-administered with simvastatin (10 mg) and high-dose statin monotherapy may show similar effects in reducing ldl-c, tg, and hs-crp levels and in increasing hdl-c levels. however, the results suggest that there was greater tc and non-hdl-c lowering through high-dose statin monotherapy as compared with ezetimibe/simvastatin co-administration.