(2018) found that ezetimibe added to statins reduced CV event risk versus a statin alone (RR: 0.94, 95% CI: 0.9 0.98).[81] Neither analysis showed a change in CV or all-cause mortality. Two secondary analyses suggest the benefit of ezetimibe is greater in high-risk patients for secondary prevention.[75,76] In Bohula et al. (2017), the Thrombolysis in Myocardial Infarction (TIMI) Risk Score for Secondary Prevention (TRS) Tool was applied to data from IMPROVE-IT to predict which patients may benefit most from the addition of ezetimibe to statins.[75] The TIMI TRS is a nine-point risk stratification tool developed from a large population of patients with atherothrombosis to predict CV death, MI, and ischemic stroke. The nine risk indicators include: CHF, hypertension, aged 75 years and older, DM, prior stroke, prior CABG, PAD, estimated glomerular filtration rate <60 mL/min, and smoking. Based upon number of risk indicators, 45% of patients (n=8,032) were low risk, 30% (n=5,292) were intermediate risk, and 25% (n=4,393) were high risk. Using the risk prediction tool, patients at high risk (>3 risk indicators) had a statistically lower incidence of the composite endpoint of CV death, MI, or ischemic stroke in the simvastatin 40 mg plus ezetimibe group versus simvastatin 40 mg alone (33.9% versus 40.2%, respectively, hazard ratio [HR]: 0.81, 95% CI: 0.73 0.9, NNT=16) and individual components of the primary endpoint.[75] Patients at intermediate risk (i.e., two risk indicators) and low risk (i.e., 0 1 risk indicator) did not show a statistically significant benefit of combination treatment versus statins alone over a period of seven years in IMPROVE-IT.[75] In another analysis of IMPROVE-IT, Giugliano et al. (2018), examined outcomes based upon the presence of DM.[76] Patients with DM were generally older and women. 