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Lower-Intensity Statin Combo Therapy Bests High-Dose Monotherapy for LDL — But So What? — Physician’s First Watch

Medical News |
February 11, 2014

Lower-Intensity Statin Combo Therapy Bests High-Dose Monotherapy for LDL — But So What?

By Amy Orciari Herman

Combination therapy with a lower-dose statin plus either a bile acid sequestrant or ezetimibe reduces LDL cholesterol better than high-dose statin monotherapy, but long-term clinical benefits remain uncertain, according to a systematic review in the Annals of Internal Medicine.

Researchers examined data from 36 randomized, controlled trials of statin therapy among high-risk adults.

A low-intensity statin, combined with a bile acid sequestrant, lowered LDL cholesterol 0%-14% more than moderate-intensity statin monotherapy. In addition, a moderate-intensity statin plus ezetimibe conferred greater LDL reductions than high-dose monotherapy among those with preexisting cardiovascular disease or diabetes. However, data were insufficient to determine whether these changes in LDL translated to reductions in rates of death, atherosclerotic cardiovascular disease, or revascularization procedures.

Asked to comment, cardiologist Harlan Krumholz of NEJM Journal Watch wrote: "This study seems a little off-note, given that the new guidelines have moved us away from lipid targets. It is far from clear that this approach will improve outcomes, which is what patients care about."

Reader Comments (5)

jean-pierre Usdin Physician, Cardiology, American hospital of Paris

why not?
if the side effects of statin are less important with this low dose combo association and the efficiency the same.
I personnaly think it is important to notice before wasting away this study and let's watch the future

FRED POLLACK Retired

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2213854/?tool=pubmed - A 2008 article

And here is a related excerpt from this article:

"The study, known as the ENHANCE (Effect of Combination Ezetimibe and High-Dose Simvastatin vs Simvastatin Alone on the Atherosclerotic Process in Patients with Heterozygous Familial Hypercholesterolemia) trial, measured the thickness of carotid artery intima media as its primary end point. Although ezetimibe did cause an additional lowering of cholesterol, plaque progression was worse in the ezetimibe arm."

PETER APOR Physician, Internal Medicine, Semmelweis University, Budapest

So many uncertainties in statin-effects. But the physical exercise works.

Richard Matthews, MD Physician, Neurology, Retired from VA Phoenix

I am retired but interested in education.
My wife has diabetes mellitus and has intolerance
with high dose statins. Thank you for this free option.

Yori Appelbaum Other Healthcare Professional, Cardiology, Athena Cardionet

Thank you very much for your excelent service.

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