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Drug Trends Cardio-Vascular Cholesterol Diabetes

Can A Low Dose Statin Combination Outperform A Moderate Dose Statin Alone And Be Safer?

1 year, 6 months ago

7467  0
Posted on Jan 18, 2023, 4 a.m.

Article courtesy of Dr. Joel Kahn, MD, who is a Clinical Professor of Medicine at Wayne State University School of Medicine, one of the world's top cardiologists, a best-selling author, lecturer, and a leading expert in plant-based nutrition and holistic care.

Many heart patients require therapy beyond lifestyle to lower LDL-cholesterol (lowering Lipoprotein(a) cholesterol if elevated is another topic not often discussed but also important). The most common approach is a moderate or high dose of a statin medication.

The RACING study compared an approach used at the KAHN CENTER for years, a low-dose statin and ezetimibe versus a moderate dose of a statin alone. In this new report, the subset with diabetes was examined and a winner was declared! Which was it?


This study reports on a subgroup analysis of diabetes mellitus (DM) patients in the larger RACING trial. The primary outcome was a 3-year composite of cardiovascular death, major cardiovascular events, or non-fatal stroke. Patients either got a moderate dose of a statin (rosuvastatin 20 mg) or were randomized to 10 mg rosuvastatin with 10 mg ezetimibe, a non-statin medication. 

Among total patients, 1398 (37.0%) had DM at baseline. The incidence of the primary outcome was 10.0% and 11.3% among patients with DM randomized to ezetimibe/statin combination therapy vs. high-intensity statin monotherapy which was not statistically different (there was no harm using the lower dose combination and there was a slight advantage that might be just chance).

Intolerance-related discontinuation or dose reduction of the study drug was observed in 5.2% and 8.7% of patients in the combination group vs. the single drug group, so there were fewer side effects with the lower dose approach.

LDL cholesterol levels <70 mg/dL at 1, 2, and 3 years were observed in 81.0%, 83.1%, and 79.9% of patients in the ezetimibe combination therapy group, and 64.1%, 70.2%, and 66.8% of patients in the statin monotherapy group which was statistically and clinically significantly favoring the combination.

In the total population, no significant interactions were found between DM status and therapy regarding the primary outcome, intolerance-related discontinuation or dose reduction, and the proportion of patients with LDL cholesterol levels <70 mg/dL.


Ezetimibe combination therapy with a lower dose statin advantages observed in the overall RACING trial population was also preserved among patients with DM.

This study supports statin with ezetimibe combination therapy as a suitable alternative to statins alone. The combination lowers the LDL-cholesterol more reliably with fewer side effects. We will continue to choose this route in patients at the KAHN CENTER. 

Finally, in patients who have inherited Lipoprotein(a), my observation is that the combination approach yields a lower Lipoprotein(a) too. 


About the author: At his core, Dr. Joel Kahn believes that plant-based nutrition is the most powerful source of preventative medicine on the planet. Having practiced traditional cardiology since 1983, it was only after his own commitment to a plant-based vegan diet that he truly began to delve into the realm of non-traditional diagnostic tools, prevention tactics, and nutrition-based recovery protocols. 

As with anything you read on the internet, this article should not be construed as medical advice; please talk to your doctor or primary care provider before changing your wellness routine. This article is not intended to provide a medical diagnosis, recommendation, treatment, or endorsement.

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