title: Model-observational bridging study on the effectiveness of ezetimibe on cardiovascular morbidity and mortality in France: A population-based study.
abstract: To evaluate the real-life impact of ezetimibe on cardiovascular (CV) morbidity and mortality in France.
  
  
  
  To estimate the number of non-fatal and fatal CV events that could be prevented and corresponding number of patients needed to treat (NNT) with ezetimibe to prevent one CV event over 5 years.
  
  
  
  Non-interventional 48-month follow-up cohort conducted in hypercholesterolemic patients starting on ezetimibe <3 months at study entry, either as monotherapy or combined with statins. Prediction modeling using discrete event simulation with calibrated Framingham CV risk equations was applied to data from pivotal clinical trials on ezetimibe and real-life data derived from the cohort.
  
  
  
  A total of 3215 patients in the cohort accumulated 9314 person-years of follow-up for an average of 2.9 years. Mean age was 61.5 (standard deviation [SD] = 10.7), 54.6% were males, and 27.0% had a history of CV disease. Baseline LDL-cholesterol averaged 4.1 mmol/L (159 mg/dL; SD = 1.0) and HDL-C 1.6 mmol/L (62 mg/dL; SD = 0.5). LDL-C decreased in the first 12 months in ezetimibe-LLT (lipid-lowering therapy) initiators, switchers (monotherapy), and combination therapy with a statin by respectively 21.3%, 6.4%, and 29.1%. The corresponding predicted rate reductions of CV events (non-fatal and fatal) compared to no treatment or to a statin (combination therapy) were respectively 8, 2, and 12 per 1000 patients treated over 5 years, with a global NNT of 143 patients over 5 years.
  
  
  
  These results, accounting for observed CV event rates, risk factors evolution over time and adherence to treatment in real life, were consistent with those from clinical trials.
authors.affiliation: Department of Cardiology, Toulouse Rangueil University Hospital, Toulouse University School of Medicine, Toulouse, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Ferrières
authors.affiliation: Department of Epidemiology and Public Health, INSERM UMR744, Pasteur Institute of Lille, University Lille Nord de France-UDSL, Lille, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Dallongeville
authors.affiliation: Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, QC, Canada; LASER Europe, London, United Kingdom.
authors.forename: Michel
authors.initials: M
authors.lastname: Rossignol
authors.affiliation: LASER Europe, London, United Kingdom; INSERM U657, University of Bordeaux Segalen, Bordeaux, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Bénichou
authors.affiliation: Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, QC, Canada; Evidera, Lexington, MA, USA.
authors.forename: J Jaime
authors.initials: JJ
authors.lastname: Caro
authors.affiliation: Evidera, Lexington, MA, USA.
authors.forename: Denis
authors.initials: D
authors.lastname: Getsios
authors.affiliation: Evidera, Lexington, MA, USA.
authors.forename: Luis
authors.initials: L
authors.lastname: Hernandez
authors.affiliation: LASER Europe, London, United Kingdom; Department of Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Lucien
authors.initials: L
authors.lastname: Abenhaim
authors.affiliation: LASER Europe, London, United Kingdom; Conservatoire national des arts et métiers (CNAM), Paris, France. Electronic address: lamiae.grimaldi@la-ser.com.
authors.forename: Lamiae
authors.initials: L
authors.lastname: Grimaldi-Bensouda
mesh_terms: D000368:Aged; D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D000069438:Ezetimibe / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006937:Hypercholesterolemia / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D015996:Survival Rate
chemical_list: D000924:Anticholesteremic Agents; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000069438:Ezetimibe
keywords: Cardiovascular disease; Cohort; Hypercholesterolemia; Lipid-modifying drugs; Prevention