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The IMProved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT) reported a significant reduction in first primary endpoint (PEP) post-acute coronary syndrome (ACS) in patients (n = 18,144) on ezetimibe + simvastatin compared with placebo + simvastatin. 1  The low density lipoprotein cholesterol (LDL-C) levels in the combination group were significantly lower than in the monotherapy group (53.7  vs  69.5 mg/dl; 1.4  vs  1.8 mmol/l).   A recent analysis of IMPROVE-IT considered all PEP events (cardiovascular [CV] death, myocardial infarction [MI], stroke, unstable angina leading to hospitalization, coronary revascularization ≥30 days post-randomization). 2  The duration of the trial was a median of 6-years (25th, 75th percentiles: 4.3 and 7.1 years). Often trials only consider the first vascular event. 2  However, this may not represent the clinical situation since patients with ACS may have recurrent events (except when the initial event is death). Assessing all events is an advantage in trials which last longer, as for IMPROVE-IT.

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