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NCT Number: NCT04626973

Effects of Ezetimibe Combination Therapy for Patients With Atherosclerotic Cardiovascular Disease; Randomized Comparison of LDL-cholesterol Targeting <70 Versus <55mg/dL; Ez-PAVE Trial

Although the clinical efficacy of LDL-cholesterol lowering therapy has been proven with strong evidences and emphasized, there are also growing concerns that intensive lipid-lowering therapy would be related to increased risk of adverse effects. In addition, statin potency from recent guidelines was set from the studies composed of mainly Caucasian population, although there is an inconsistency of statin effect according to ethnicity. Asian population showed more profound LDL reduction not only from high potent statin but also from moderate to low potent statin. Conventional strategies for lowering LDL-cholesterol focused on statins, therefore doubling of previously described dose of statin would be common way in patients with inadequate LDL-cholesterol levels. Adding ezetimibe will be an alternative strategy not only to lower LDL-cholesterol level and also to reduce the need of dosage of high-intensity statin to achieve sufficient LDL-cholesterol lowering effect. However, studies regarding the effect of intensive-targeting of lipid-lowering therapy and therapy regimens are lacking. Thus, on these basis, we sought to evaluate whether intensive-targeting of lipid-lowering therapy will have more prominent beneficial effect compared to conventional-targeting in patients with documented ASCVD with either an ezetimibe/statin combination therapy or a statin monotherapy.

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Key information

Conditions

Atherosclerotic Cardiovascular Disease Arterial Occlusive Diseases Arteriosclerosis Atherosclerosis Cardiovascular Diseases Coronary Artery Disease Coronary Disease Dyslipidemias Heart Diseases Lipid Metabolism Disorders Metabolic Diseases Myocardial Ischemia Nutritional and Metabolic Diseases Vascular Diseases

Age range

19 year–80 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Division of Cardiology, Yonsei Cardiovascular Hospital, Yonsei University College of Medicine

Seoul, South Korea

About this study

All eligible patients who have documented ASCVD will be enrolled according to inclusion/exclusion criteria after voluntary agreement with informed consent. At the time of enrollment, we will stratify all patients according to LDL-cholesterol <100mg/dL, DM, and acute coronary syndrome, and randomly assign them in two groups according to LDL-cholesterol targeting level with a 1:1 ratio: "Intensive-targeting group" vs. "Conventional-targeting group". In addition, patients in each group will be randomly assigned to receive two lipid-lowering therapy regimen with a 1:1 ratio: "Ezetimibe/Statin combination therapy" vs. "Statin monotherapy". Patients allocated to each treatment group will receive lipid-lowering therapy with following protocols.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Age 19-80 years
  • Documented atherosclerotic cardiovascular disease (ASCVD)
  • Previous acute coronary syndrome (myocardial infarction [MI] or unstable angina),
  • Or stable angina with imaging or functional studies
  • Or coronary revascularization (percutaneous coronary intervention [PCI], coronary artery bypass graft [CABG], and other arterial revascularization procedures)
  • Or stroke and transient ischemic attack (TIA)
  • Or peripheral artery disease

Exclusion criteria

  • LDL-cholesterol level less than 70 mg/dL without statin therapyAllergy or hypersensitive to ezetimibe or statin
  • Active liver disease or persistent unexplained serum AST/ALT elevation more than 2 times the upper limit of normal range
  • Allergy or hypersensitivity to any statin or ezetimibe
  • Solid organ transplantation recipient
  • Pregnant women, women with potential childbearing, or lactating women
  • Life expectancy less than 3 years
  • Inability to follow the patient over the period of 1 year after enrollment, as assessed by the investigator
  • Inability to understand or read the informed content

Treatment and study plan

Ezetimibe/Statin Combination therarpy (ezetimibe plus rosuvastatin)

Drug

For statin naive patients, patients would initially receive Ezetimibe 10mg plus Rosuvastatin 10 or 20 mg.

For non-statin naive patients, regimens are to be changed to the equivalent dose of ezetimibe+rosuvastatin combination in case of already achieved LDL-cholesterol target (<55 mg/dL) and to be dosed up than the equivalent dose of study drugs in case of not yet achieved LDL-cholesterol target.

Statin monotherapy (rosuvastatin or atorvastatin)

Drug

For statin naive patients, patients would initially receive Rosuvastatin 20mg or Atorvastatin 40 or 80 mg.

For non-statin native patients, regimens are to be change to equivalent dose of atorvastatin or rosuvastatin in case of already achieved LDL-cholesterol target (<55 mg/dL) and to be dosed up than the equivalent dose of study drugs in case of not yet achieved LDL-cholesterol target.

Primary outcomes

  1. Clinical outcomes by different lipid-lowering therapy

    Time frame: Within 3 years after the enrollment

    Composite of cardiovascular death, non-fatal MI, non-fatal stroke, any revascularization, and hospitalization for unstable angina

Secondary outcomes

  1. Each component of primary endpoint within 3 years

    Time frame: Within 3 years after the enrollment

    • A. Rate of Cardiovascular death
    • B. Rate of non-fatal MI
    • C. Rate of non-fatal stroke
    • D. Rate of any revascularization
    • E. Rate of hospitalization for unstable angina

  2. Various composite outcomes within 3 years

    Time frame: Within 3 years after the enrollment

    • A. Rate of composite of cardiovascular death, non-fatal MI, and non-fatal stroke
    • B. Rate of composite of cardiovascular death, non-fatal MI, non-fatal stroke, and any revascularization
    • C. Rate pf composite of cardiovascular death, non-fatal MI, and any revascularization
    • D. Rate of composite of all-cause death, non-fatal MI, non-fatal stroke, any revascularization, and hospitalization for unstable angina

  3. Proportion of subjects achieving target LDL-cholesterol level

    Time frame: Within 3 years after the enrollment

  4. Rate of cross-over into the non-allocated therapy regimen in order to achieve target LDL-cholesterol level

    Time frame: Within 3 years after the enrollment

  5. Proportions of subjects requiring proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor to achieve target LDL-cholesterol level

    Time frame: Within 3 years after the enrollment

  6. Difference in rate of primary outcome according to sex

    Time frame: Within 3 years after the enrollment

  7. Difference in rate of primary outcome according to body mass index

    Time frame: Within 3 years after the enrollment

  8. Rate of New-onset diabetes mellitus

    Time frame: Within 3 years after the enrollment

  9. Rate of worsening of glycemic control or homeostatic model assessment (HOMA)-index

    Time frame: Within 3 years after the enrollment

  10. Occurrence of statin-associated muscle symptoms (SAMS) requiring change of therapy regimen or dosage

    Time frame: Within 3 years after the enrollment

  11. Occurence of elevation of muscle enzymes (CPK > 4 x UNL)

    Time frame: Within 3 years after the enrollment

  12. Occurence of elevation of hepatic enzymes (AST, ALT, or both ≥ 3 x UNL)

    Time frame: Within 3 years after the enrollment

  13. Occurence of elevation of serum creatinine level (>50% from baseline)

    Time frame: Within 3 years after the enrollment

  14. Change of proteinuria

    Time frame: Within 3 years after the enrollment

  15. Rate of cancer diagnosis

    Time frame: Within 3 years after the enrollment

  16. Rate of operation due to cataract

    Time frame: Within 3 years after the enrollment

Sponsors and collaborators

Lead sponsor

Yonsei University

Other

Registry information

Important dates

Study start
2021
Primary completion
2025
Study completion
2025
First posted
Nov 13, 2020
Registry last updated
Nov 17, 2025

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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