On-treatment analysis of the Improved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT)

Michael A. Blazing, Robert P. Giugliano, James A de Lemos, Christopher P. Cannon, Andrew Tonkin, Christie M. Ballantyne, Basil S. Lewis, Thomas A. Musliner, Andrew M. Tershakovec, Yuliya Lokhnygina, Jennifer A. White, Craig Reist, Amy McCagg, Eugene Braunwald

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


Background We aimed to determine the efficacy and safety of adding ezetimibe (Ez) to simvastatin (S) in a post–acute coronary syndrome (ACS) population in a prespecified on-treatment analysis. Methods We evaluated 17,706 post-ACS patients from the IMPROVE-IT trial who had low-density lipoprotein cholesterol values between 50 and 125 mg/dL and who received Ez 10 mg/d with S 40 mg/d (Ez/S) or placebo with simvastatin 40 mg/d (P/S). The primary composite end point was cardiovascular death, myocardial infarction, unstable angina, coronary revascularization ≥30 days postrandomization, or stroke. The on-treatment analysis included patients who received study drug for the duration of the trial or experienced a primary end point or noncardiovascular death within 30 days of drug discontinuation. Results Mean low-density lipoprotein cholesterol values at 1 year were 71 mg/dL for P/S and 54 mg/dL for Ez/S (absolute difference −17 mg/dL = −24%; P <.001). The 7-year Kaplan-Meier estimate of the primary end point occurred in 32.4% in the P/S arm and 29.8% in the Ez/S arm (absolute difference 2.6%; HRadj 0.92 [95% CI 0.87-0.98]; P =.01). The absolute treatment effect favoring Ez/S was 30% greater than in the intention-to-treat analysis of IMPROVE-IT. Conclusions This analysis provides additional support for the efficacy and safety of adding Ez to S in this high-risk, post-ACS population.

Original languageEnglish (US)
Pages (from-to)89-96
Number of pages8
JournalAmerican heart journal
StatePublished - Dec 1 2016

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


Dive into the research topics of 'On-treatment analysis of the Improved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT)'. Together they form a unique fingerprint.

Cite this