Ez-PAVE: statin plus ezetimibe reached LDL target faster, 44.3% vs 18.3% at one month
In the open-label Ez-PAVE trial, initial statin plus ezetimibe reached the LDL target faster than statin alone, with no significant difference in cardiovascular events over three years.
Results of the Ez-PAVE clinical trial were presented on 7 November 2026 at the AHA Scientific Sessions in Chicago and published simultaneously in Circulation, according to ad-hoc-news.de. Researchers from Severance Hospital of Yonsei University in Seoul, including Kim Byeong-Keuk and Lee Sang-hyup, took part in the study. It compared an initial combination of a statin and ezetimibe with statin monotherapy for lowering LDL cholesterol. The combination reached the target values considerably faster. ad-hoc-news.de
ad-hoc-news.dead-hoc-news.deOpen source ↗
LDL targets: combination vs monotherapy
For the intensive target of below 55 mg/dL, 44.3% of patients on the combination reached it after one month, versus 18.3% on monotherapy. After one year the rates were 55.7% versus 30.0%, and after three years 69.4% versus 52.2%.
For the conventional target of below 70 mg/dL, 71.6% of the combination group were within range after one month versus 47.1% on monotherapy. After three years the shares were 73.2% and 63.1%. Over the three-year follow-up, median LDL in the intensive-target arms was 53 mg/dL on the combination and 62 mg/dL on monotherapy. In the conventional-target arms the medians were 63 and 70 mg/dL.
During the study, 34.3% of monotherapy patients with the intensive target and 24.8% with the conventional target received ezetimibe in addition. ad-hoc-news.de
ad-hoc-news.dead-hoc-news.deOpen source ↗
Clinical endpoints and safety
The primary endpoint combined cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, revascularization and hospitalization for unstable angina. It occurred 128 times (8.5%) with the combination and 119 times (7.9%) with monotherapy (hazard ratio 1.07; 95% CI 0.83–1.37; P=0.596), so the difference was not significant.
The benefit of the lower LDL target was consistent regardless of the starting regimen (P for interaction 0.583). An earlier randomization phase, presented at ACC 2026, had shown a hazard ratio of 0.67 in favor of the lower target.
Safety profiles were comparable. New-onset diabetes occurred in 17.1% of patients on the combination and 15.6% on monotherapy. Muscle symptoms were recorded in 0.7% and 0.9%, respectively. ad-hoc-news.de
ad-hoc-news.dead-hoc-news.deOpen source ↗
Kim Byeong-Keuk said that starting with the two-drug combination did not reduce cardiovascular events. For patients with stable vascular disease, he described starting with a statin and adding ezetimibe as needed, with regular monitoring and dose adjustment, as a reasonable strategy. The American Heart Association noted that the result refers to the initial strategy when later dose adjustments are possible. It does not show that monotherapy suffices for all patients in the long term.
The study had an open design, three years of follow-up and a cohort of mostly male South Korean patients. It was also not primarily powered for clinical endpoints.
