title: Statin combination therapy and cardiovascular risk reduction.
abstract: In numerous clinical trials, lowering LDL-C with statin therapy has been demonstrated to reduce the risk of cardiovascular disease (CVD) in primary and secondary prevention settings. Guidelines recommend statins for first-line therapy in cholesterol-lowering management of patients with CVD risk. Despite increased statin monotherapy use over the last decade, a number of patients with high CVD risk do not achieve optimal LDL-C lowering. Guidelines recommend consideration of statin combination therapy with nonstatin agents for these patients. However, combination therapy approaches have been hampered by neutral findings. Recently, ezetimibe added to simvastatin therapy reduced cardiovascular events in acute coronary syndrome patients, more than simvastatin alone. This article provides an overview of various agents in combination with statin therapy on cardiovascular outcomes. Other lipid-lowering agents in development, including PCSK9 and CETP inhibitors in development, are also described.
authors.affiliation: CGH Medical Center, Sterling, Illinois, & Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Peter P
authors.initials: PP
authors.lastname: Toth
authors.affiliation: Lipid Clinic, Point Médical, Dijon, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Farnier
authors.affiliation: Merck & Co., Inc., Kenilworth, NJ, USA.
authors.forename: Joanne E
authors.initials: JE
authors.lastname: Tomassini
authors.affiliation: Merck & Co., Inc., Kenilworth, NJ, USA.
authors.forename: JoAnne M
authors.initials: JM
authors.lastname: Foody
authors.affiliation: Merck & Co., Inc., Kenilworth, NJ, USA.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Tershakovec
mesh_terms: D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D008078:Cholesterol, LDL / Q000097:blood*; D004359:Drug Therapy, Combination; D000069438:Ezetimibe / Q000627:therapeutic use; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D011322:Primary Prevention; D012307:Risk Factors; D055502:Secondary Prevention; D019821:Simvastatin / Q000627:therapeutic use
chemical_list: D000924:Anticholesteremic Agents; D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D019821:Simvastatin; D000069438:Ezetimibe
keywords: CETP; PCSK9; bile acid sequestrants; combination therapy; ezetimibe; fibrates; niacin; omega 3-polyunsaturated long-chain fatty acids; statin