Ezetimibe vs statins safety
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Safety of Ezetimibe vs Statins: Key Findings
Muscle and Liver-Related Side Effects: Ezetimibe Plus Statin vs High-Intensity Statin
Multiple studies show that combining ezetimibe with a low or moderate-intensity statin results in fewer muscle-related side effects and less liver enzyme elevation compared to high-intensity statin monotherapy. High-intensity statins are more likely to increase aspartate aminotransferase (AST) and creatine kinase (CK), markers of liver and muscle injury, while the combination therapy is associated with lower rates of muscle symptoms and intolerance-related drug discontinuation or dose reduction, especially in elderly patients 135710.
General Adverse Events: Ezetimibe Plus Statin vs Higher Statin Dose
When comparing ezetimibe plus statin to simply doubling the statin dose, the combination therapy achieves better LDL cholesterol reduction without increasing the overall rate of adverse events. The risk of any adverse event, including gastrointestinal or musculoskeletal issues, is similar between the two approaches 49.
Safety in Special Populations: Elderly, Diabetes, and Chronic Kidney Disease
In elderly patients, moderate-intensity statin plus ezetimibe is as effective as high-intensity statin monotherapy for preventing cardiovascular events, but with fewer cases of drug intolerance and discontinuation 107. In patients with diabetes or high cardiovascular risk, adding ezetimibe to statin therapy does not increase safety concerns and may provide additional cardiovascular benefits 27. For those with chronic kidney disease, the combination therapy improves lipid profiles and reduces cardiovascular events and all-cause mortality, with no significant increase in adverse events compared to statin alone .
Safety in Children and Adolescents
For children and adolescents with familial hypercholesterolemia, statins, ezetimibe, and their combination are all considered safe and well-tolerated, with no evidence of differences in maturation or safety compared to placebo. However, long-term safety data are still limited .
Conclusion
Ezetimibe combined with low or moderate-intensity statin is generally as safe or safer than high-intensity statin monotherapy or simply increasing the statin dose. The combination therapy is associated with fewer muscle and liver-related side effects, similar rates of general adverse events, and better tolerability, especially in elderly and high-risk patients. This makes ezetimibe plus statin a preferable option for many patients who are at risk of statin intolerance or adverse effects 134578910.
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