The Imheartproved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT) by Cannon et al. is the first clinical trial to show a benefit of adding a non statin lipid-modifying agent to statin therapy. The trial included 18,144 patients with an acute coronary syndrome who were randomly assigned to either simvastatin (40 mg) plus ezetimibe (10 mg) or to simvastatin (40 mg) plus placebo. After 7 years cardiovascular death, major coronary event or nonfatal stroke were 2 % significantly lower in the simvastatin-plus-ezetimibe group than in the simvastatin-monotherapy group (32.7% vs. 34.7%). The IMPROV-IT trial supported that excess low-density lipoprotein (LDL) cholesterol is a causal factor in the development of atherosclerotic vascular disease; suggesting that reducing LDL cholesterol levels, regardless of the mechanism, should produce a corresponding reduction in cardiovascular events. What are your thoughts about the results of this research? How will this change your practice?

For additional information please read NEJM

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