{
  "abstract": "Background: Many patients fail to achieve low-density lipoprotein cholesterol (LDL-C) targets with statin monotherapy, calling for a combination of statins and ezetimibe. This systematic review and network meta-analysis evaluated the comparative effectiveness and safety of atorvastatin monotherapy, atorvastatin/ezetimibe free-equivalent combination (AS/EZ FEC), and fixed-dose combination (AS/EZ FDC) in patients with hypercholesterolemia.\n\nMethods: Randomized controlled trials were retrieved from electronic databases. Primary outcomes were the percentage change in LDL-C from baseline and LDL-C goal attainment, analyzed using mean difference (MD) and risk ratio (RR) with 95% confidence intervals (CI). Treatments were ranked via surface under the cumulative ranking curve (SUCRA). The two combination therapies were compared to AS alone for their safety profiles and tolerability. Forty-six trials ( n = 10,567) were included.\n\nResults: AS/EZ FDC reduced LDL-C more than AS alone (MD −13.94%, 95% CI [−18.90% to −9.10%]), with similar results for AS/EZ FEC (MD −12.41%, 95% CI [−14.61% to −10.22%]). SUCRA rankings for LDL-C reduction were FDC (86.2%), FEC (63.8%), and AS (0.0%). For LDL-C goal attainment, the RR was 1.87 (95% CI [1.47–2.39]) for FEC vs. monotherapy, 1.80 (95% CI [0.85–3.81]) for FDC vs. monotherapy. No significant differences in safety profiles were observed between treatments.\n\nConclusion: AS/EZ combination therapies provide greater improvements in LDL-C reduction and goal attainment compared with AS monotherapy, with FDC ranking highest in LDL-C reduction. Treatment with AS/EZ FEC or FDC did not increase the risk of adverse events compared to AS monotherapy and was well tolerated. These findings support FDC use when intensive LDL-C lowering is required.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China",
    "Medical Affairs and Outcomes Research, Organon China, Shanghai, China"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 4,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Juying Qian"
    },
    {
      "affs": [
        1
      ],
      "name": "Xingxin Zhang"
    },
    {
      "affs": [
        0
      ],
      "name": "Qing Li"
    },
    {
      "affs": [
        1
      ],
      "name": "Sisi Chen"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/7ypwqxy6r2nh6.bib",
  "cited_by": 0,
  "doi": "10.7717/peerj.21784",
  "fulltext_url": "https://europepmc.org/articles/PMC13695417",
  "id": "7ypwqxy6r2nh6",
  "issns": [
    "2167-8359"
  ],
  "landing_url": "https://peerj.com/articles/21784",
  "language": "eng",
  "licence": "CC-BY-NC-4.0",
  "licence_label": "CC BY-NC 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0",
  "metadata_licence": null,
  "native_subjects": [
    [
      "lcc",
      "QH301-705.5"
    ],
    [
      "lcc",
      "R"
    ],
    [
      "openalex",
      "2746|Lipoproteins and Cardiovascular Health"
    ]
  ],
  "openalex": "W7223094171",
  "pdf_url": "https://peerj.com/articles/21784.pdf",
  "pmcid": "PMC13695417",
  "pmid": "42927391",
  "published": "2026-10-21",
  "publisher": "PeerJ",
  "ris": "https://research.draconitic.com/paper/7ypwqxy6r2nh6.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:47Z",
      "native_id": "10.7717/peerj.21784",
      "source": "crossref",
      "url": "https://peerj.com/articles/21784"
    },
    {
      "first_seen": "2026-10-30T12:21:18Z",
      "native_id": "MED:42927391",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42927391"
    },
    {
      "first_seen": "2026-10-30T13:44:14Z",
      "native_id": "30ca3f779e61451b8c071244d5dce604",
      "source": "doaj",
      "url": "https://doi.org/10.7717/peerj.21784"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2746|Lipoproteins and Cardiovascular Health",
      "subfield": "surgery"
    }
  ],
  "title": "Effectiveness and safety of atorvastatin/ ezetimibe fixed-dose combination in hypercholesterolemia: a systematic review and network meta-analysis",
  "title_text": "Effectiveness and safety of atorvastatin/ ezetimibe fixed-dose combination in hypercholesterolemia: a systematic review and network meta-analysis",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T13:44:14Z",
  "url": "https://research.draconitic.com/paper/7ypwqxy6r2nh6",
  "venue": "PeerJ",
  "versions": []
}