Clinical Comparison of Low-dose Rosuvastatin Plus Ezetimibe Combination Therapy and High-dose Rosuvastatin Monotherapy in Patients With Minimal to Intermediate Coronary Artery Disease Without Percutaneous Coronary Intervention

Overview

\[Purpose of the Clinical Study\]:The purpose of this study is to conduct a clinical comparison of low-dose rosuvastatin plus ezetimibe combination therapy and high-dose rosuvastatin monotherapy in patients with minimal to intermediate coronary artery disease without percutaneous coronary intervention to confirm non-inferiority in the reduction of key cardiovascular events. \[Hypothesis\]:In patients who have not undergone percutaneous coronary intervention for minimal to moderate coronary artery disease, low-dose rosuvastatin and ezetimibe combination therapy are non-inferior in terms of reducing major cardiovascular events compared to high-dose rosuvastatin monotherapy.

\[Background\]:While high-dose statin is becoming more important, there are factors that limit more widespread use of such a treatment due to the possibility of adverse events, especially among the patients from East Asia. These factors include muscle-related diseases, higher liver figures, and onset of diabetes. Meanwhile, the combination treatment of low-dose statin and ezetimibe, which slows down the absorption of LDL cholesterol, can see an equivalent level of LDL cholesterol reduction compared to high-dose statin treatments, while having an advantage in terms of the level of decrease in adverse events. However, further verification is still needed whether the statin + ezetimibe combination therapy and the high-dose statin monotherapy of the same reduction effect against LDL cholesterol would have the same level of clinical utility. Especially with regard to the treatment of patients with minimal to minor coronary artery diseases, there are no available guidelines for the use of statin. In the case of a stenosis lesion with a 50 to 70% severity level, the likelihood of choosing medication over percutaneous coronary artery interventions through a physiological evaluation is increasing compared to the past. Also, some studies suggested that the MACE of an intermediate lesion showed a difference depending on the administration of statin, while percutaneous coronary intervention did not. Therefore, verification of the clinical utility on the said lesions is also necessary. \[Clinical Research Plan\]: A prospective, multicenter, randomized, and public label clinical study involving a total of 6,356 patients, 3,178 patients each with ezetimibe 10mg/rosuvastatin 5mg (experimental group) and rosuvastatin 20mg (active control group), in patients who have not undergone percutaneous coronary intervention for minimal to moderate coronary artery disease. After random assignment, take the assigned drugs for 3 years and follow-up observation is conducted at 6weeks, 6, 12, and 36 months. Test personnel can follow up through hospital visits or phone visits. The primary end-points are a combined assessment variable of all cause death, cardiovascular deaths, myocardial infarction without death, stroke without death, hospitalization due to unstable angina, and revascularization after random assignment at 36 months.