Statin and ezetimibe combination therapy in cardiovascular disease.

PURPOSE OF REVIEW: To summarize the available data regarding the benefits of combination therapy with statins and ezetimibe in patients with cardiovascular disease. RECENT
FINDINGS: Extensive evidence, mostly in statin outcome trials, has shown that the magnitude of cardiovascular benefit is directly proportional to the degree of LDL cholesterol (LDL-C) reduction. As such, aggressive target goals for LDL-C levels have been established by guideline committees. Although statins are considered first-line agents in lipid therapy, LDL-C targets are difficult to achieve with statin therapy alone. Ezetimibe, a cholesterol absorption inhibitor, has been shown to be well tolerated and effective in lowering LDL-C. Adding ezetimibe to ongoing statin therapy leads to a substantial additional reduction in LDL-C, facilitating the achievement of target goals.
SUMMARY: The combination of ezetimibe, a cholesterol absorption inhibitor, and statins has been shown to be well tolerated and effective in lowering LDL-C and high-sensitivity C-reactive protein to target goals. Whether this greater LDL-C reduction translates into reduced cardiovascular events is the subject of ongoing clinical trials. Until such data is available, ezetimibe seems to be a reasonable choice for a second-line, lipid-lowering agent in patients on a potent statin who are not at their LDL-C goal.