Combination therapy of statin and ezetimibe for the treatment of familial hypercholesterolemia.
High-dose potent statin therapy in combination with ezetimibe is now standard practice for the treatment of adult patients with heterozygous familial hypercholesterolemia (heFH), as the result of numerous studies in patients with primary hypercholesterolemia or heFH. These studies have shown the combination to be both effective and safe in the short to medium term. Recently, short-term ezetimibe therapy has also been shown to be effective and safe in combination with statin therapy for children and adolescents with heFH. Effective statin-ezetimibe combination therapy is capable of achieving near-normal lipid profiles in heFH patients, with expected improvement in risk for cardiovascular disease (CVD) and improved life expectancy resulting predominantly from reduction in levels of low-density lipoprotein cholesterol. There are few data to support a pleiotropic action of ezetimibe with regard to CVD benefit, unlike therapy with statins. No serious and unexpected clinical adverse effects of combination statin-ezetimibe therapy have emerged till date, although data are limited in children and adolescents, for whom longer-term studies are required. Recent data suggesting possible proatherogenic effects of ezetimibe require confirmation. One large long-term randomized controlled clinical outcomes trial is in progress in non-FH patients to determine the efficacy and safety of ezetimibe therapy; it is unlikely that such a trial will ever be performed in patients with FH.
Griffith University School of Medicine, Southport, Queensland, Australia. ihcgriffith@gmail.com
Ian
I
Hamilton-Craig
Karam
K
Kostner
David
D
Colquhoun
Stan
S
Woodhouse
D000818:Animals; D000924:Anticholesteremic Agents / Q000494:pharmacology / Q000592:standards / Q000627:therapeutic use*; D001384:Azetidines / Q000494:pharmacology / Q000592:standards / Q000627:therapeutic use*; D008078:Cholesterol, LDL / Q000097:blood / Q000187:drug effects*; D004195:Disease Models, Animal; D004359:Drug Therapy, Combination; D050171:Dyslipidemias / Q000188:drug therapy / Q000209:etiology; D000069438:Ezetimibe; D015658:HIV Infections / Q000150:complications; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000494:pharmacology; D006938:Hyperlipoproteinemia Type II / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
D000924:Anticholesteremic Agents; D001384:Azetidines; D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000069438:Ezetimibe