title: Defining the Place of Ezetimibe/Atorvastatin in the Management of Hyperlipidemia.
abstract: Statin-ezetimibe combinations are a potentially advantageous therapeutic option for high-risk patients who need additional lowering of low-density lipoprotein cholesterol (LDL-C). These combinations may overcome some of the limitations of statin monotherapy by blocking both sources of cholesterol. Recently, a fixed-dose combination with atorvastatin, one of the most extensively studied statins, was approved and launched in several countries, including the USA. Depending on atorvastatin dose, this combination provides LDL-C reductions of 50-60%, triglyceride reductions of 30-40%, and high-density lipoprotein cholesterol (HDL-C) increases of 5-9%. Studies comparing the lipid-lowering efficacy of the atorvastatin-ezetimibe combination with the alternatives of statin dose titration or switching to a more potent statin consistently showed that combination therapy provided greater LDL-C reduction, translating into a greater proportion of patients achieving lipid goals. Simvastatin-ezetimibe combinations have been shown to reduce the incidence of major atherosclerotic events in several clinical settings to a magnitude that seems similar to that observed with statins for the same degree of absolute LDL-C lowering. The atorvastatin-ezetimibe combination has also been shown to induce the regression of coronary atherosclerosis measured by intravascular ultrasound in a significantly greater proportion of patients than atorvastatin alone. Atorvastatin-ezetimibe combinations are generally well tolerated. Previous concerns of a possible increase in the incidence of cancer with ezetimibe were dismissed in large trials with long follow-up periods. In this paper, we examine the rationale for an atorvastatin-ezetimibe combination, review the evidence supporting it, and discuss its potential role in the management of dyslipidemia.
authors.affiliation: Cardiology Department, Hospital Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.
authors.forename: António Miguel
authors.initials: AM
authors.lastname: Ferreira
authors.affiliation: Arterial Investigation Unit, Department of Medicine 4, Hospital Santa Marta, Centro Hospitalar de Lisboa Central, EPE, Rua de Santa Marta, 1169-1024, Lisbon, Portugal. pedro.silva@chlc.min-saude.pt.
authors.forename: Pedro
authors.initials: P
authors.lastname: Marques da Silva
mesh_terms: D000924:Anticholesteremic Agents / Q000008:administration & dosage*; D000069059:Atorvastatin / Q000008:administration & dosage*; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D004359:Drug Therapy, Combination / Q000379:methods; D000069438:Ezetimibe / Q000008:administration & dosage*; D006801:Humans; D006949:Hyperlipidemias / Q000097:blood / Q000188:drug therapy*; D019821:Simvastatin / Q000008:administration & dosage
chemical_list: D000924:Anticholesteremic Agents; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D000069059:Atorvastatin; D019821:Simvastatin; D000069438:Ezetimibe