The IMPROVE-IT Trial: Lessons Learned and Clinical Implications

IMPROVE-IT is a randomized, active-control, double-blind study of subjects with stabilized high-risk acute coronary syndrome. The primary objective is to evaluate the clinical benefit of lowering LDL-cholesterol in high-risk patients with the non-statin agent ezetimibe in addition to statin therapy to further reduce cardiovascular events.

Target Audience

Cardiologists, Endocrinologists, Family Physicians, General Internists, Gynecologists and Physician Assistants.

Learning Objectives

  • Discuss the incremental clinical benefit of lowering LDL-cholesterol in high-risk patients with the non-statin agent ezetimibe in addition to statin therapy to further reduce cardiovascular events.
  • Recognize that the LDL-cholesterol hypothesis ("lower is better") was supported by the IMPROVE-IT Trial. 
  • Discuss the safety of ezetimibe. 
Additional information
Bibliography: 
  • Blazing MA, Giugliano RP, Cannon CP, Musliner TA, Tershakovec AM, White JA, Reist C, McCagg A, Braunwald E, Califf RM. Evaluating cardiovascular event reduction with ezetimibe as an adjunct to simvastatin in 18,144 patients after acute coronary syndromes: final baseline characteristics of the IMPROVE-IT study population. Am Heart J. 2014 Aug;168(2):205-12.e1. doi: 10.1016/j.ahj.2014.05.004. Epub 2014 May 15. 
  • Califf RM, Lokhnygina Y, Cannon CP, Stepanavage ME, McCabe CH, Musliner TA, Pasternak RC, Blazing MA, Giugliano RP, Harrington RA, Braunwald E. An update on the IMProved reduction of outcomes: Vytorin Efficacy International Trial (IMPROVE-IT) design. Am Heart J. 2010 May;159(5):705-9. doi: 10.1016/j.ahj.2010.03.004. Epub 2010 Mar 15. 
  • Azar RR, Badaoui G, Sarkis A, Azar M, Aydanian H, Harb S, Achkouty G, Kassab R. Effect of ezetimibe/atorvastatin combination on oxidized low density lipoprotein cholesterol in patients with coronary artery disease or coronary artery disease equivalent. Am J Cardiol. 2010 Jul 15;106(2):193-7. doi: 10.1016/j.amjcard.2010.03.016. 
  • Cannon CP, Giugliano RP, Blazing MA, Harrington RA, Peterson JL, Sisk CM, Strony J, Musliner TA, McCabe CH, Veltri E, Braunwald E, Califf RM; IMPROVE-IT Investigators. Rationale and design of IMPROVE-IT (IMProved Reduction of Outcomes: Vytorin Efficacy International Trial): comparison of ezetimbe/simvastatin versus simvastatin monotherapy on cardiovascular outcomes in patients with acute coronary syndromes. Am Heart J. 2008 Nov;156(5):826-32. doi: 10.1016/j.ahj.2008.07.023. Epub 2008 Sep 2. 
  • Drazen JM, Jarcho JA, Morrissey S, Curfman GD. Cholesterol lowering and ezetimibe. N Engl J Med. 2008 Apr 3;358(14):1507-8. doi: 10.1056/NEJMe0801842. Epub 2008 Mar 30. 
Course summary
Available credit: 
  • 0.50 AMA PRA Category 1 Credit™
  • 0.50 General certificate of attendance
Course opens: 
05/15/2016
Course expires: 
05/15/2017

Michael Ozner, M.D., FACC, FAHA
Medical Director, Center for Prevention and Wellness
Baptist Health South Florida
Voluntary Assistant Professor of Medicine (Cardiology) 
University of Miami Miller School of Medicine
Miami, Florida

Michael Ozner, M.D., FACC, FAHA, indicated that neither he nor his spouse/partner has relevant financial relationships with commercial interest companies, and he will not include off-label or unapproved product usage in his presentations or discussions. 

Non-faculty contributors and others involved in the planning, development and editing/review of the content have no relevant financial relationships to disclose. 

Disclosure Policy and Disclaimer 

Available Credit

  • 0.50 AMA PRA Category 1 Credit™
  • 0.50 General certificate of attendance

Accreditation Period

Course opens: 
05/15/2016
Course expires: 
05/15/2017
Please login or register to take this course.

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