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Racin Trial

Guidelines and several studies have well established the need to reduce LDL cholesterol levels in patients with atherosclerotic cardiovascular diseases (ASCVD) to reduce cardiovascular events. Indeed, every 38·7 mg/dL (1 mmol/L) reduction in LDL cholesterol is associated with a risk reduction of major vascular events independent of drug class.

However, rather than increasing the doses of statins alone, recent evidence showed that greater efficacy and lower risks can be achieved by use of drug combinations such as statins with Ezetimibe. Furthermore, as adverse effects of statin therapy are more associated with the use of high-intensity statins, the addition of ezetimibe can reduce the risk of these adverse effects.

The RACING study is the first randomized clinical trial that compare the long-term clinical outcomes between a combination of Rosuvastatin10mg/Ezetimibe10mg versus Rosuvastatin 20mg in 3,780 patients with established ASCVD1.

Among patients with atherosclerotic cardiovascular disease, the combination of Rosuvastatin 10 mg with Ezetimibe 10 mg enabled a higher proportion of patients to achieve a LDL cholesterol levels of less than 70 mg/dL and lowered intolerance-related drug discontinuation or dose reduction versus Rosuvastatin 20mg (Figure 1). In addition, the combination Rosuvastatin10mg/Ezetimibe10mg was non-inferior to Rosuvastatin 20mg for the primary endpoint, a 3-year composite of cardiovascular death, major cardiovascular events, or non-fatal stroke1.

These results support the guidelines that recommend the early addition of ezetimibe for patients with ASCVD who are at high cardiovascular risk2. In fact, these patients are unlikely to achieve LDL cholesterol target with high-dose statins, even when doubling the statin dose. This approach enables to avoid repeated follow-up and allows patients to be on target rapidly, with a favorable impact on cardiovascular outcomes.

Byeong-Keuk Kim, Sung-Jin Hong et al. Long-term efficacy and safety of moderate-intensity statin with ezetimibe combination therapy versus high-intensity statin monotherapy in patients with atherosclerotic cardiovascular disease (RACING): a randomised, open-label, non-inferiority trial, Lancet 2022; 400: 380–90

Averna M et al. Atherosclerosis. 2021;325:99-109. doi:10.1016/j.atherosclerosis.2021.03.039

LDL: Low Density Lipoprotein

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Figure 1.

Discontinuation or dose reduction of Rosuvastatin 10 mg with Ezetimibe 10 mg (Moderate intensity statin with ezetimibe combination therapy) or of Rosuvastatin 20mg (High intensity statin monotherapy) due to intolerance

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