Starting cholesterol treatment with a statin alone or combining it with ezetimibe leads to similar heart and stroke outcomes over three years, according to findings presented at the American Heart Association’s Scientific Sessions 2026.
Across 17 medical centers in South Korea, the study followed over 3,000 participants diagnosed with cardiovascular or blood vessel conditions. Researchers evaluated whether starting with a dual-drug regimen yielded better protection than starting on a statin and adding ezetimibe if needed to reach an assigned low-density lipoprotein (LDL) goal.
For the combination group, the combined incidence of cardiovascular death, myocardial infarction, cerebrovascular accidents, interventions to unblock arteries, or hospital admissions for worsening angina reached 8.5%, compared to 7.9% for the participants taking only a statin—a variance lacking statistical significance.
Cholesterol Goals in Focus
Investigators assigned participants to an assigned low-density lipoprotein (LDL) or bad cholesterol goal.
Many patients initially placed on monotherapy eventually required ezetimibe to meet their assigned thresholds. About one in three individuals (more than 34%) in the lower-goal LDL group and about one in four (nearly 25%) in the conventional LDL-goal group had ezetimibe added during follow-up.
Weighing Early Combination Therapy
According to the findings, initiating treatment with both drugs simultaneously does not inherently decrease the occurrence of strokes, heart attacks, or related cardiovascular events relative to beginning with a single statin and introducing extra drugs subsequently. “Doctors can lower LDL cholesterol with a statin alone or in combination with ezetimibe, which lowers cholesterol more.
However, it remains unclear if starting both together reduces heart attacks, strokes and other heart issues compared to starting with a statin alone and adding additional medications like ezetimibe later,” said study author Byeong-Keuk Kim, M.D., Ph.D., a professor of cardiology at Yonsei University College of Medicine’s Severance Hospital in Seoul, South Korea.
Experts note that beginning treatment with a statin and incorporating ezetimibe subsequently is a practical strategy for stable vascular patients, though administering both simultaneously can accelerate LDL reduction when baseline numbers greatly exceed targets. Meta-analyses indicate that while combination regimens lower lipid levels more aggressively than doubling statin doses, there is no additional clinical benefit regarding myocardial infarction, angina or nonfatal stroke.
