title: Clinical implications of the IMPROVE-IT trial in the light of current and future lipid-lowering treatment options.
abstract: BACKGROUND
  A residual risk of morbidity and mortality from cardiovascular (CV) disease remains despite statin therapy. This situation has generated an interest in finding novel approaches of combining statins with other lipid-lowering agents, or finding new lipid and non-lipid targets, such as triglycerides, high-density lipoprotein cholesterol (HDL-C), non-HDL-C, proprotein convertase subtilisin/kexin type 9 (PCSK9) gene, cholesterol ester transfer protein (CETP), lipoprotein (a), fibrinogen or C-reactive protein.
  
  
  METHODS
  The recent results from the IMProved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT) demonstrated an incremental clinical benefit when ezetimibe, a non-statin agent, was added to simvastatin therapy.
  
  
  CONCLUSIONS
  The results from IMPROVE-IT revalidated the concept that low-density lipoprotein cholesterol (LDL-C) levels are a clinically relevant treatment goal. This trial also suggested that further decrease of LDL-C levels (53 vs. 70 mg/dl; 1.4 vs. 1.8 mmol/l) was more beneficial in lowering CV events. This "even lower is even better" evidence for LDL-C levels may influence future guidelines and the use of new drugs. Furthermore, these findings make ezetimibe a more realistic option to treat patients with statin intolerance or those who cannot achieve LDL-C targets with statin monotherapy.
authors.affiliation: a Department of Epidemiology , University of Alabama at Birmingham , Birmingham , USA.|b Department of Functional Sciences, Discipline of Pathophysiology , "Victor Babes" University of Medicine and Pharmacy , Timisoara , Romania.
authors.forename: Maria-Corina
authors.initials: MC
authors.lastname: Serban
authors.affiliation: c Department of Hypertension, Chair of Nephrology and Hypertension , Medical University of Lodz , Lodz , Poland.
authors.forename: Maciej
authors.initials: M
authors.lastname: Banach
authors.affiliation: d Department of Clinical Biochemistry, Royal Free Campus, University College London Medical School , University College London (UCL) , London , UK.
authors.forename: Dimitri P
authors.initials: DP
authors.lastname: Mikhailidis
mesh_terms: D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000517:prevention & control; D008078:Cholesterol, LDL / Q000097:blood; D004359:Drug Therapy, Combination; D050171:Dyslipidemias / Q000188:drug therapy*; D000069438:Ezetimibe / Q000627:therapeutic use*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D019821:Simvastatin / Q000627:therapeutic use
chemical_list: D000924:Anticholesteremic Agents; D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D019821:Simvastatin; D000069438:Ezetimibe
keywords: Ezetimibe; IMPROVE-IT; low-density lipoprotein cholesterol; simvastatin; statin