Metabolic & Cardiometabolic
rosuvastatin + ezetimibe combination decreases cardiovascular disease
Part of: 💊 statins, 💊 ezetimibe
📅 Last reviewed: 2026-07-15 ⓘ
Evidence ladder
How far up the ladder this claim has climbed. A high consensus on a low rung means "consistent so far," not "proven in people."
Top evidence so far: All trials, pooled (Meta-analysis)
How the studies fall
What the evidence shows
A moderate statin + ezetimibe is non-inferior to high-intensity statin monotherapy for 3-year CV outcomes, achieves LDL<70 more often, and has ~half the intolerance-related discontinuations (RACING). Validates the statin-sparing STRATEGY - but RACING used rosuvastatin 10 mg (not 5 mg), so LDL-equivalence at 5 mg is the open question -> follow-up lipid panel.
The evidence (10)
| Source | Grade | Stance | Quality | Finding |
|---|---|---|---|---|
| Cha JJ et al 2026 · study_type: RCT | RCT | supports | moderate | SaveSAMS subgroup, age≥70, n=318: moderate-statin+eze vs high-intensity statin. Δnon-HDL -76 vs -66mg/dL (P=.047); LDL target attainment comparable; SAMS 0.7% vs 5.4% (P=.021) |
| Liu 2024 · PLoS One | meta-analysis | mixed | low | Meta: moderate rosuvastatin+ezetimibe non-inferior to high-intensity rosuvastatin for CV events, fewer discontinuations |
| Ji 2025 · Lipids Health Dis | RCT | supports | low | ROSE-CH RCT: fixed-dose rosuvastatin/ezetimibe lowered LDL more than rosuvastatin monotherapy |
| Lee YJ et al] # corrected 2026-08-17 from PubMed; was [(RACING MetS subgroup) 2023 · (RCT) | RCT | supports | moderate | [FT-verified] RACING MetS post-hoc subgroup HR 0.97 (0.72-1.32); non-inferiority holds in metabolic-syndrome pts |
| Cheng S et al] # corrected 2026-08-17 from PubMed; was [Kim BK, et al. (RACING) 2022 · Lancet | RCT | supports | moderate | RACING n=3,780 RCT: rosuvastatin10+ezetimibe non-inferior to rosuvastatin20; discontinuation 4.8% vs 8.2%; PMID scholar-confirmed |
| Sajid EU et al 2026 · study_type: meta-analysis | meta-analysis | supports | low | 9 studies, n=179,621, post-PCI: MACE RR 0.96 (95% CI 0.81-1.12, no sig diff = NI); CV mortality RR 0.83 (0.71-0.98); MI RR 0.74 (0.58-0.95) |
| Zhou Y et al 2026 · study_type: meta-analysis | meta-analysis | supports | low | 12 studies, n=25,591 DM patients at high MI risk: ezetimibe-statin vs statin monotherapy MACE RR 0.90 (95% CI 0.82-0.99, P=.02); all-cause/CV death, MI similar |
| Choo EH, Moon D, Choi IJ, et al. 2024 · Cardiovasc Diabetol | observational | supports | moderate | Nationwide South Korean claims cohort, 45,501 post-PCI patients; propensity-score-matched 7,161 pairs: MACCE (all-cause death, revascularisation, ischaemic stroke) 33.8% on high-intensity statin vs 31% on moderate-intensity statin + ezetimibe. Real-world corroboration of the statin-sparing strategy; observational, so residual confounding by indication remains possible. |
| Kim 2022 · Lancet | RCT | supports | high | CORRECTED RACING PMID: open-label NI RCT n=3780 ASCVD; 3yr CV 9.1% vs 9.9% diff -0.78% (90%CI -2.39,0.83); non-inferior, fewer drug-intol discontinuations |
| Lee DH et al 2025 · study_type: observational | observational | contradicts | moderate | Korean cohort+case-control, n=26,937 ischemic stroke: ezetimibe+atorvastatin cut recurrent IS (aHR 0.73, 95%CI 0.55-0.98); ezetimibe+rosuvastatin showed no effect (aHR 1.00, 0.80-1.24) |
Disagree, or know a study we missed?
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