Ezetimibe-Simvastatin Therapy Reduce Recurrent Ischemic Stroke Risks in Type 2 Diabetic Patients

• Published in: The journal of clinical endocrinology and metabolism 2016-08, Vol.101 (8), p.2994-3001
• Main Authors: Liu, Chi-Hung, Chen, Tien-Hsing, Lin, Ming-Shyan, Hung, Ming-Jui, Chung, Chang-Ming, Cherng, Wen-Jin, Lee, Tsong-Hai, Lin, Yu-Sheng
• Format: Article
• Language: English
• Subjects: Aged; Anticholesteremic Agents - therapeutic use; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - mortality; Ezetimibe, Simvastatin Drug Combination - therapeutic use; Female; Humans; Ischemic Attack, Transient - mortality; Ischemic Attack, Transient - prevention & control; Male; Middle Aged; Recurrence; Retrospective Studies; Risk Factors; Stroke - mortality; Stroke - prevention & control; Taiwan - epidemiology
• ISSN: 0021-972X; 1945-7197
• DOI: 10.1210/jc.2016-1831

Context: Statin is the main lipid-lowering therapy for type 2 diabetes mellitus patients. Recent evidence suggested the cardiovascular protective effects of ezetimibe-simvastatin in acute coronary syndrome patients. Objective: To investigate the effect of ezetimibe-simvastatin combination therapy on stroke prevention among diabetic stroke patients. Design, Setting, Participants, and Outcome Measures: This is a retrospective cohort study. Between March 1, 2009 and December 31, 2011, all patients with type 2 diabetes mellitus in Taiwan's National Health Insurance Research Database were screened. Those admitted for ischemic stroke (IS) were recruited and divided into 10-mg ezetimibe-20-mg simvastatin (EZ-SIM), 40-mg atorvastatin (ATOR), and 20-mg simvastatin (SIM) groups for further analyses. The primary outcomes were IS, myocardial infarction, and death from any cause. Patients were followed from index hospitalization to the date of death, loss of follow-up, or study termination. Results: During the 34-month follow-up period, the risk of recurrent IS in the SIM group was higher than that of the ATOR (hazard ratio [HR], 2.03; 95% confidence interval [CI], 1.46–2.82) and EZ-SIM (HR, 1.69; 95% CI, 1.14–2.50) groups. The risk of recurrent IS was not significantly lower in the EZ-SIM compared with the ATOR group (HR, 1.20; 95% CI, 0.85–1.69). The incidence of composite endpoint was highest in the SIM group (28.2%), followed by the ATOR (16.1%) and EZ-SIM (15.4%) groups. The multivariate adjusted survival curve showed lower trends of recurrent IS in the EZ-SIM and ATOR groups compared with the SIM group. Conclusions: High-potency lipid-lowering therapy effectively reduces the risk of recurrent IS in diabetic patients regardless of ATOR or EZ-SIM combination therapy. This study shows that high-potency lipid-lowering therapy is helpful for reducing the recurrence of ischemic stroke risks in DM patients, regardless of high-intensity statin alone or ezetimibe-simvastatin combination therapy is used.