A new role for combination therapy in lipid management

Coronary heart disease (CHD) is the primary cause of death in Europe and the United States. High serum concentrations of low-density lipoprotein cholesterol (LDL-C) increase the risk of CHD. Despite published guidelines for assessment and treatment of hypercholesterolaemia, many patients are inadequately treated and many do not reach target LDL-C goals. Statins are the most frequently used class of drug for treatment of hypercholesterolaemia but most patients do not achieve target goals with starting statin doses. High doses of statins, or statins combined with other lipid-modifying agents, may be used to reach LDL-C targets, but these strategies are associated with an increased risk of side effects and low patient acceptance. New agents that can be used safely alone or in combination with statins to attain target goals are needed. Combining drugs with effects on different pathways of cholesterol metabolism may provide benefits that are complementary and additive to those of the statins. For example, ezetimibe, the first selective cholesterol absorption inhibitor, effectively blocks intestinal absorption of dietary and biliary cholesterol and, when co-administered with a statin, provides an additional 16% to 18% reduction in LDL-C levels. The need for less frequent statin dosage adjustments may lead to improved patient compliance and help more patients to attain their LDL-C goals.