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, Shin Y, Joo HJ, Park JH, Yu CW, Lee PH, Lee SW, Lee CW, Moon JY, Lee JY, Kim JS, Park JS, Hong SJ 2026 · Journal of the American Heart Association | 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 L, Deng Y, Li L, Yang X, Yin Z, Lai Y 2024 · PLoS One | meta-analysis | mixed | low | Meta: moderate rosuvastatin+ezetimibe non-inferior to high-intensity rosuvastatin for CV events, fewer discontinuations |
| Ji X, Xia J, Zhang H, Ren C, Ma G, Fu S, Zhang J, Chen Y, Han X, Zhang J, Fang Z, Yang B, Yang B, Huang W, Yin G, Qi H, Gong H, Wang D, Hao L, Zhao X, Pei Z, Wang P, Li X, Lin L, Li D, Li Z, Zhang L, Yin B, Cheng Y, You Z, Sheng J, Wu J, Chen L, Fan Z, Zhao W, Zhao S 2025 · Lipids Health Dis | RCT | supports | low | ROSE-CH RCT: fixed-dose rosuvastatin/ezetimibe lowered LDL more than rosuvastatin monotherapy |
| Lee YJ, Lee SH, You SC, Lee YH, Lee SJ, Hong SJ, Ahn CM, Kim BK, Ko YG, Choi D, Hong MK, Jang Y, Kim JS 2023 · (RCT) | RCT | supports | moderate | RACING MetS post-hoc subgroup HR 0.97 (0.72-1.32); non-inferiority holds in metabolic-syndrome pts |
| Cheng S, Mittnenzweig M, Mayshar Y, Lifshitz A, Dunjić M, Rais Y, Ben-Yair R, Gehrs S, Chomsky E, Mukamel Z, Rubinstein H, Schlereth K, Reines N, Orenbuch AH, Tanay A, Stelzer Y 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, Azeem MH, Fatima A, Jafri SM, Hassan D, Ibrahim T, Manjee KZ, Ahmed SR, Ali T, Shakeel R, Usman M, Mahato RK, Bawa D 2026 · Clinical cardiology | 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, Jin J 2026 · BMC cardiovascular disorders | 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, Lim S, Lee J, Kang D, Hwang BH, Kim CJ, Lee JM, Yoo KD, Jeon DS, Chang K 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 BK, Hong SJ, Lee YJ, Hong SJ, Yun KH, Hong BK, Heo JH, Rha SW, Cho YH, Lee SJ, Ahn CM, Kim JS, Ko YG, Choi D, Jang Y, Hong MK, RACING investigators 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, Park YA, Choi SA, Kim JS, Yee J, Gwak HS 2025 · Journal of the American Heart Association | 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) |
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