Emily G McDonald1, Ramy R Saleh2, Todd C Lee3. 1. Division of General Internal Medicine, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada. Electronic address: emily.mcdonald@mail.mcgill.ca. 2. Division of General Internal Medicine, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada. 3. Division of General Internal Medicine, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada; Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada; McGill Centre for Quality Improvement, Montreal, Quebec, Canada.
Abstract
OBJECTIVES: The US Food and Drug Administration licensed ezetimibe in 2002 because of its ability to lower low-density lipoprotein cholesterol levels, a surrogate marker for the risk of coronary artery disease. The negative results of the Effect of Ezetimibe Plus Simvastatin Versus Simvastatin Alone on Atherosclerosis in the Carotid Artery trial were published in 2008. Since then, we have seen 6 additional years without a landmark study in favor of ezetimibe. Furthermore, the new American Heart Association/American College of Cardiology guidelines (2013) now strongly downplay the use of nonstatin agents. We sought to determine whether ezetimibe use remains common in 2014 using a new cohort that we have created to teach residents how to perform clinically relevant research. METHODS: The McGill Teaching Unit Cohort is an anonymized prospective cohort study enrolling all patients admitted to the medical clinical teaching units of the Royal Victoria Hospital in Montréal, Québec, Canada, as of 2014. Information collected includes the receipt of cholesterol-lowering medications and other important demographics. RESULTS: Of the 783 patients enrolled on the date of analysis, 331 (42.7%) were receiving treatment for hypercholesterolemia. Of these, 156 (47%) were receiving primary prophylaxis. Overall, 323 patients (98%) were receiving a statin, 17 patients (5.1%) were receiving ezetimibe, and 5 patients (1.5%) were receiving a fibrate. Users of ezetimibe were more likely to be active smokers than nonusers (6/17 vs 42/314, P = .01); however, there were no other significant differences between important covariates or recent low-density lipoprotein measurements. CONCLUSIONS: Ezetimibe use remains common amongst medical inpatients despite a lack of evidence supporting its efficacy.
OBJECTIVES: The US Food and Drug Administration licensed ezetimibe in 2002 because of its ability to lower low-density lipoprotein cholesterol levels, a surrogate marker for the risk of coronary artery disease. The negative results of the Effect of Ezetimibe Plus Simvastatin Versus Simvastatin Alone on Atherosclerosis in the Carotid Artery trial were published in 2008. Since then, we have seen 6 additional years without a landmark study in favor of ezetimibe. Furthermore, the new American Heart Association/American College of Cardiology guidelines (2013) now strongly downplay the use of nonstatin agents. We sought to determine whether ezetimibe use remains common in 2014 using a new cohort that we have created to teach residents how to perform clinically relevant research. METHODS: The McGill Teaching Unit Cohort is an anonymized prospective cohort study enrolling all patients admitted to the medical clinical teaching units of the Royal Victoria Hospital in Montréal, Québec, Canada, as of 2014. Information collected includes the receipt of cholesterol-lowering medications and other important demographics. RESULTS: Of the 783 patients enrolled on the date of analysis, 331 (42.7%) were receiving treatment for hypercholesterolemia. Of these, 156 (47%) were receiving primary prophylaxis. Overall, 323 patients (98%) were receiving a statin, 17 patients (5.1%) were receiving ezetimibe, and 5 patients (1.5%) were receiving a fibrate. Users of ezetimibe were more likely to be active smokers than nonusers (6/17 vs 42/314, P = .01); however, there were no other significant differences between important covariates or recent low-density lipoprotein measurements. CONCLUSIONS:Ezetimibe use remains common amongst medical inpatients despite a lack of evidence supporting its efficacy.
Authors: Marc-Alexandre Gingras; Anthony Lieu; Louise Papillon-Ferland; Todd C Lee; Emily G McDonald Journal: J Hosp Med Date: 2019-05-12 Impact factor: 2.960