Comparison of the Effects of Ezetimibe-Statin Combination Therapy on Major Adverse Cardiovascular Events in Patients with and without Diabetes: A Meta-Analysis

BACKGROUND: Ezetimibe-statin combination therapy has been found to reduce low density lipoprotein cholesterol levels and the risk of major adverse cardiovascular events (MACEs) in large trials. We sought to examine the differential effect of ezetimibe on MACEs when added to statins according to the presence of diabetes. METHODS: Randomized clinical trials with a sample size of at least 50 participants and at least 24 weeks of follow-up that compared ezetimibe-statin combination therapy with a statin- or placebo-controlled arm and reported at least one MACE, stratified by diabetes status, were included in the meta-analysis and meta-regression. RESULTS: A total of seven trials with 28,191 enrolled patients (mean age, 63.6 years; 75.1% men; 7,298 with diabetes [25.9%]; mean follow-up, 5 years) were analysed. MACEs stratified by diabetes were obtained from the published data (two trials) or through direct contact (five trials). No significant heterogeneity was observed among studies (I 2=14.7%, P=0.293). Ezetimibe was associated with a greater reduction of MACE risk in subjects with diabetes than in those without diabetes (pooled relative risk, 0.84 vs. 0.93; P heterogeneity=0.012). In the meta-regression analysis, the presence of diabetes was associated with a greater reduction of MACE risk when ezetimibe was added to statins (β=0.87, P=0.038). CONCLUSION: Ezetimibe-statin combination therapy was associated with greater cardiovascular benefits in patients with diabetes than in those without diabetes. Our findings suggest that ezetimibe-statin combination therapy might be a useful strategy in patients with diabetes at a residual risk of MACEs.

Evaluation of thoracic trauma in dogs and cats: a review of seventeen cases

The objective of this study was to assess the etiology, diagnosis, treatment methods, surgical findings, postoperative results and necropsy findings of seventeen cases of thoracic trauma by evaluating medical records. A car accident, falling down, stabbing and bites were identified as the causes of trauma. Diagnosed pathologies in the cases included pneumothorax, hemothorax, pulmonary contusion, lung lobe collapse or eventration, rib fractures, etc. The treatment methods employed in these cases were medical therapy, thoracocentesis, tube thoracostomy, lateral intercostal thoracotomy, median sternotomy and thoracic wall revisions. Atelectasis, rupture, laceration or contusion of the lung lobes, pulmonary artery rupture, rib fracture and etc. were the surgical findings. Overall, seven dogs and four cats recovered completely. Two dogs were euthanized due to other pathologies including multisegmental lumbar fracture, paraplegia and postpneumonectomy syndrome. Three dogs and a cat died during treatment management. The necropsies revealed that the animals had pulmonary artery and tracheobronchial ruptures. The cat also had sudden onset cardiac arrest during surgery. In conclusion, cases with thoracic trauma should be assessed closely and managed with the necessary emergency and surgical procedures