title: Effectiveness of a combination of ezetimibe and statins in patients with acute coronary syndrome and multiple comorbidities: A 6-year population-based cohort study.
abstract: BACKGROUND
  The clinical benefits of a combination of statins and ezetimibe in patients with acute coronary syndrome (ACS) were observed in a clinical trial. However, little is known regarding the effectiveness of using statins with or without ezetimibe in patients with ACS and multiple comorbidities in real-world clinical practice.
  
  
  METHODS
  This is a nationwide population-based cohort study using Taiwan National Health Insurance Research Database. A total of 212,110 patients with ACS who had been discharged after their first ACS events between 2006 and 2010 were enrolled. A propensity score matching approach was used to create matched cohorts for adjusting potential confounders. Cox proportional hazards regressions were performed to estimate the risk of re-hospitalization for ACS and revascularization.
  
  
  RESULTS
  Patients in the statins-plus-ezetimibe group had a significantly lower risk of re-hospitalization for ACS (adjusted hazard ratio [HR]=0.64, 95% confidence interval [CI]: 0.60-0.69) and revascularization (HR=0.69, 95% CI: 0.63-0.76) than those in the statins-alone group. In the statins-plus-ezetimibe group, female patients had a lower risk of re-hospitalization for ACS than male patients did, and patients without diabetes mellitus had a lower risk of re-hospitalization for ACS than did patients with diabetes mellitus.
  
  
  CONCLUSIONS
  Patients with ACS and multiple comorbidities receiving a combination therapy of statins and ezetimibe had a lower risk of re-hospitalization for ACS and revascularization than those receiving statins alone. Significant interaction effects were observed between combination with ezetimibe, sex, and diabetes mellitus.
authors.affiliation: School of Pharmacy, College of Medicine, National Taiwan University, No.33, Linsen S. Rd., Zhongzheng Dist., Taipei 10050, Taiwan; Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, No.33, Linsen S. Rd., Zhongzheng Dist., Taipei 10050, Taiwan; Department of Pharmacy, National Taiwan University Hospital, No.1, Changde St., Zhongzheng Dist., Taipei 10048, Taiwan.
authors.forename: Fe-Lin
authors.initials: FL
authors.lastname: Lin Wu
authors.affiliation: Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, No.17, Xu-Zhou Road, Taipei, Taiwan.
authors.forename: Jui
authors.initials: J
authors.lastname: Wang
authors.affiliation: School of Pharmacy, College of Medicine, National Taiwan University, No.33, Linsen S. Rd., Zhongzheng Dist., Taipei 10050, Taiwan; Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, No.33, Linsen S. Rd., Zhongzheng Dist., Taipei 10050, Taiwan.
authors.forename: Wei
authors.initials: W
authors.lastname: Ho
authors.affiliation: General Internal Medicine, The University of Chicago, Edward H. Levi Hall, 5801 South Ellis Avenue, Chicago, IL 60637, USA; Center for Translational and Policy Research of Chronic Diseases, The University of Chicago, Edward H. Levi Hall 5801 South Ellis Avenue, Chicago, IL 60637, USA.
authors.forename: Chia-Hung
authors.initials: CH
authors.lastname: Chou
authors.affiliation: School of Pharmacy, College of Medicine, National Taiwan University, No.33, Linsen S. Rd., Zhongzheng Dist., Taipei 10050, Taiwan; Graduate Institute of Pharmaceutical Science, College of Medicine, National Taiwan University, No.33, Linsen S. Rd., Zhongzheng Dist., Taipei 10050, Taiwan.
authors.forename: Yi-Jung
authors.initials: YJ
authors.lastname: Wu
authors.affiliation: School of Pharmacy, College of Medicine, National Taiwan University, No.33, Linsen S. Rd., Zhongzheng Dist., Taipei 10050, Taiwan; Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, No.33, Linsen S. Rd., Zhongzheng Dist., Taipei 10050, Taiwan.
authors.forename: Dan-Wei
authors.initials: DW
authors.lastname: Choo
authors.affiliation: School of Pharmacy, College of Medicine, National Taiwan University, No.33, Linsen S. Rd., Zhongzheng Dist., Taipei 10050, Taiwan; Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, No.33, Linsen S. Rd., Zhongzheng Dist., Taipei 10050, Taiwan.
authors.forename: Yu-Wen
authors.initials: YW
authors.lastname: Wang
authors.affiliation: School of Pharmacy, College of Medicine, National Taiwan University, No.33, Linsen S. Rd., Zhongzheng Dist., Taipei 10050, Taiwan.
authors.forename: Po-Yu
authors.initials: PY
authors.lastname: Chen
authors.affiliation: Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, No.17, Xu-Zhou Road, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, No.1, Changde St., Zhongzheng Dist., Taipei 10048, Taiwan.
authors.forename: Kuo-Liong
authors.initials: KL
authors.lastname: Chien
authors.affiliation: School of Pharmacy, College of Medicine, National Taiwan University, No.33, Linsen S. Rd., Zhongzheng Dist., Taipei 10050, Taiwan; Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, No.33, Linsen S. Rd., Zhongzheng Dist., Taipei 10050, Taiwan; Department of Pharmacy, National Taiwan University Hospital, No.1, Changde St., Zhongzheng Dist., Taipei 10048, Taiwan; Graduate Institute of Pharmaceutical Science, College of Medicine, National Taiwan University, No.33, Linsen S. Rd., Zhongzheng Dist., Taipei 10050, Taiwan. Electronic address: zflin@ntu.edu.tw.
authors.forename: Zhen-Fang
authors.initials: ZF
authors.lastname: Lin
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000453:epidemiology; D000368:Aged; D000924:Anticholesteremic Agents / Q000008:administration & dosage; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology*; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D050171:Dyslipidemias / Q000188:drug therapy / Q000453:epidemiology*; D000069438:Ezetimibe / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D057216:Propensity Score; D015996:Survival Rate / Q000639:trends; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000924:Anticholesteremic Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000069438:Ezetimibe
keywords: Acute coronary syndrome; Comorbidity; Ezetimibe; Statin