title: IMPROVE-IT: what have we learned?
abstract: Recent studies and dyslipidemia treatment guidelines indicate that combination lipid-lowering therapy is frequently needed and its use has increased in recent years. Ezetimibe and simvastatin as a fixed dose is an efficacious treatment choice based on positive results of the recent IMProved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT). In this review, we discuss recent controversies surrounding ezetimibe and provide clinical perspective on the results of the IMPROVE-IT study.
  
  
  
  IMPROVE-IT is the first trial that demonstrates a significant clinical benefit of a nonstatin hypolipidemic agent (ezetimibe) used in combination with statin (simvastatin) therapy in patients who have experienced an acute coronary syndrome. For almost a decade, the use of ezetimibe was limited by a relative lack of definitive evidence. However, the most recent Plaque Regression With Cholesterol Absorption Inhibitor or Synthesis Inhibitor Evaluated by Intravascular Ultrasound study showed greater coronary plaque regression by statin/ezetimibe combination compared with statin monotherapy. The results of the IMPROVE-IT trial are fostering new debate about the value of adjunctive low-density lipoprotein cholesterol lowering over and above a statin.
  
  
  
  Ezetimibe/simvastatin combination, either as a single pill or as the combined use of the individual compounds, represents a well-tolerated and efficacious choice for dyslipidemia treatment in high-risk subjects, including patients with diabetes. Limited additional risk for adverse events compared with simvastatin monotherapy is observed, and an individualized, patient-centered approach to therapy is recommended.
authors.affiliation: aDepartment of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Poland bBiomedical Department of Internal Medicine and Medical Specialties, University of Palermo cEuro-Mediterranean Institute of Science and Technology, Palermo, Italy dCGH Medical Centre, Sterling, Illinois; University of Illinois, School of Medicine, Peoria, Illinois eJohns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Maciej
authors.initials: M
authors.lastname: Banach
authors.forename: Dragana
authors.initials: D
authors.lastname: Nikolic
authors.forename: Manfredi
authors.initials: M
authors.lastname: Rizzo
authors.forename: Peter P
authors.initials: PP
authors.lastname: Toth
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy*; D000924:Anticholesteremic Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D001384:Azetidines / Q000627:therapeutic use; D008078:Cholesterol, LDL; D004359:Drug Therapy, Combination; D000069438:Ezetimibe / Q000008:administration & dosage* / Q000627:therapeutic use*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D006937:Hypercholesterolemia / Q000188:drug therapy*; D019821:Simvastatin / Q000008:administration & dosage* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000924:Anticholesteremic Agents; D001384:Azetidines; D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D019821:Simvastatin; D000069438:Ezetimibe