Refining the Decision to Use Ezetimibe: Results of an IMPROVE-IT Reanalysis

In the industry-funded IMPROVE-IT trial of people with a recent acute coronary syndrome and treated with simvastatin, ezetimibe reduced the relative risk of a composite cardiovascular endpoint (cardiovascular death, major coronary event, or stroke) by 6% at 7 years of follow-up (NEJM JW Cardiol Jul 2015 and N Engl J Med 2015; 372:2387). Because a prespecified subgroup analysis suggested that diabetes modified the effect of ezetimibe, the trial investigators specifically studied this possible interaction.

Overall, 4933 study participants (27%) had diabetes, based on history of diabetes, antidiabetic treatment, or fasting blood sugar >126 mg/dL. People with diabetes were more likely to be older, to be female, and to have a prior myocardial inf…