Comparison of Rosuvastatin and Rosuvastatin Plus Ezetimibe in Reducing Low-Density Lipoproteins

Abstract

Background: Dyslipidaemia, particularly elevated low-density lipoprotein cholesterol (LDL-C), is a leading modifiable risk factor for cardiovascular disease (CVD), which accounts for approximately 30–40% of adult mortality in Pakistan. Despite statin availability, LDL-C target attainment remains poor in high-risk Pakistani patients, necessitating evaluation of combination lipid-lowering strategies. Objective: To compare the efficacy and safety of rosuvastatin monotherapy versus rosuvastatin-ezetimibe combination therapy in reducing LDL-C among high-risk cardiovascular patients at a tertiary care centre in Peshawar, Pakistan. Methods: A retrospective cohort study was conducted between June 2022 and June 2023 (n = 150; 75 per arm). Adults aged 30–75 years with hypercholesterolaemia (LDL-C ≥100 mg/dL) and established CVD risk factors were included. Fasting lipid profiles were recorded at baseline and at 12 weeks. The primary outcome was absolute and proportional LDL-C reduction; secondary outcomes included changes in total cholesterol, triglycerides, HDL-C, and apolipoprotein B (ApoB). Between-group comparisons were performed using independent-samples t-tests, with Bonferroni correction applied for secondary outcomes. Results: Baseline LDL-C was comparable between groups (144.12 ± 26.12 vs 142.46 ± 24.98 mg/dL; p = 0.681). At 12 weeks, LDL-C decreased to 91.60 ± 28.90 mg/dL in the rosuvastatin arm (36.5% reduction) and to 88.75 ± 29.73 mg/dL in the combination arm (37.7% reduction); the between-group difference was 2.85 mg/dL (95% CI: 0.39–5.31; p = 0.0234). Neither group achieved the guideline LDL-C target of <70 mg/dL. HDL-C improvement favoured combination therapy (p = 0.015); ApoB reduction did not differ significantly between groups (p = 0.084). Adverse events were mild and comparable across arms. Conclusion: Rosuvastatin-ezetimibe combination therapy produced a statistically significant but modest incremental LDL-C reduction compared with rosuvastatin monotherapy; however, the failure of both regimens to achieve guideline targets highlights the need for earlier and more aggressive lipid management in high-risk Pakistani patients.