Finding
In response to Thomopoulous and Michalopoulou, we agree that hypertension is a well-described risk factor for stroke and is reasonable to consider when assessing the potential mechanism of benefit for ezetimibe on the risk of ischemic stroke.
Paper
Response by Bohula et al to Letters Regarding Article, "Prevention of Stroke With the Addition of Ezetimibe to Statin Therapy in Patients With Acute Coronary Syndrome in IMPROVE-IT (Improved Reduction of Outcomes: Vytorin Efficacy International Trial)".
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Semantic ScholarAbstract
In response to Thomopoulous and Michalopoulou, we agree that hypertension is a well-described risk factor for stroke and is reasonable to consider when assessing the potential mechanism of benefit for ezetimibe on the risk of ischemic stroke. It is important to note that blood pressure was well controlled in this population after acute coronary syndrome with a median baseline blood pressure of 123/72 mm Hg (interquartile range of 110–136/65–80). There was a small change over time, with no clinically significant difference between randomized treatment (median blood pressure at 12 months for ezetimibe/simvastatin 130/78 mm Hg [119–140/70–83] and simvastatin alone 130/78 mm Hg [120–141/70–83]). Although we cannot rule out other mechanisms for the benefit of ezetimibe for ischemic stroke, we suspect that it is related primarily to low-density lipoprotein (LDL) cholesterol reduction given the consistency of our findings with that of the Cholesterol Treatment Trialists’ meta-analysis.1,2 In addition, an anti-inflammatory effect, as reflected in reductions in high-sensitivity C-reactive protein, may also contribute to benefit for the reduction in atherothrombotic events.3 With regard to the comments by Del Pinto et al, although a clinical history of hypertension was a …
Authors
E. Bohula, S. Wiviott, R. Giugliano
Journal
Circulation
Very Rigorous Journal