{"id":"a1df67a5c7ec","type":"article","url":"https://hartvaat.nl/2016/12/21/ezetimibe-bij-post-cabg-patienten-met-acs-improve-it-subanalyse/","title":"Ezetimibe bij post-CABG patiënten met ACS: IMPROVE-IT-subanalyse","title_en":"The benefit of adding ezetimibe to statin therapy in patients with prior coronary artery bypass graft surgery and acute coronary syndrome in the IMPROVE-IT trial.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog"],"tags":["acuut-hartfalen","ouderen"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehw377","source_url":"https://doi.org/10.1093/eurheartj/ehw377","authors":["Alon Eisen","Christopher P Cannon","Michael A Blazing","Erin A Bohula","Jeong-Gun Park","Sabina A Murphy","Jennifer A White","Robert P Giugliano","Eugene Braunwald"],"significance":6,"published":"2016-12-21","source_date":"2016-12-21","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/lipiden/lipidenmedicatie-bij-ckd/"],"congress":"","summary_en":"This IMPROVE-IT subanalysis showed that patients with prior CABG derive particular benefit from adding ezetimibe to statin therapy after ACS, reflecting their higher baseline cardiovascular risk and greater potential for LDL lowering.","created":"2026-07-03T10:26:28Z","updated":"2026-07-03T13:25:48Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Subanalyse van IMPROVE-IT naar het voordeel van ezetimibe-toevoeging bij ACS-patiënten met eerdere CABG. Deze subgroep heeft een verhoogd risico en mogelijk meer baat bij intensieve LDL-verlaging.","abstract_original":"AIMS: To examine the efficacy and safety of ezetimibe added to statin in patients with prior coronary artery bypass graft surgery (CABG) following hospitalization for an acute coronary syndrome (ACS). METHODS AND RESULTS: In the IMPROVE-IT trial, post-ACS patients with mean low density lipoprotein cholesterol (LDL-C) of 93.8 mg/dL at presentation were randomized to simvastatin/ezetimibe or simvastatin/placebo. The primary endpoint was cardiovascular death, major coronary event or stroke, and the median follow-up was 6 years. Efficacy and safety endpoints were examined by prior CABG status. Among 18 134 patients, 1684 (9.3%) had a prior CABG (median age 69 years, 82% male). During the trial, the median time-weighted LDL-C level was 55.0 mg/dL with simvastatin/ezetimibe vs. 69.9 mg/dL with simvastatin/placebo in patients with prior CABG (P < 0.001), and it was 53.6 mg/dL vs. 69.5 mg/dL, respectively, in patients without prior CABG (P < 0.001). The rate of the primary endpoint was higher in patients with vs. without prior CABG [56% vs. 32%, adj. hazard ratio 1.45, 95% confidence interval (CI) 1.33-1.58]. Patients with prior CABG receiving simvastatin/ezetimibe had an 8.8% (95% CI 3.1-14.6%) lower absolute risk over simvastatin/placebo in the primary endpoint, whereas patients without prior CABG had a 1.3% (95% CI 0-2.6%) lower absolute risk (P-interaction = 0.02). There were no between-group significant differences in safety endpoints. CONCLUSION: The clinical benefit of adding ezetimibe to statin appears to be enhanced in patients with prior CABG, supporting the use of intensive lipid lowering therapy in these high-risk patients following ACS."}