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The IMPROVE-IT trial: current status and potential clinical implications of ezetimibe

Finn Akerstrm, Luis Rodriguez-Padial

Reduction in low-density lipoprotein cholesterol (LDL-C) decreases the burden of coronary artery disease. The 3‑hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) improve cardiovascular disease outcomes by reduction of LDL-C and are currently considered first-line therapy for patients with hypercholesterolemia. Recent evidence has resulted in current guidelines recommending a more aggressive approach, with lower LDL-C goals in high-risk patients. However, despite high doses of statin therapy, targets are not met in all patients. Ezetimibe reduces cholesterol levels, in particular LDL-C, by inhibiting the intestinal absorption of both biliary and dietary cholesterol. When combined with a statin, LDL-C levels are further decreased. Ezetimibe is therefore an attractive adjunct agent to statin therapy when LDL-C targets are not achieved, yet its clinical benefits on cardiovascular outcomes await additional clinical trials. The Improved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVEIT) is an ongoing multicenter, randomized, double-blind trial that aims to determine whether the addition of ezetimibe to statin therapy improves cardiovascular outcomes in patients with acute coronary syndrome