Defining the Place of Ezetimibe/Atorvastatin in the Management of Hyperlipidemia

被引:26
作者
Ferreira, Antonio Miguel [1 ]
da Silva, Pedro Marques [2 ]
机构
[1] Ctr Hosp Lisboa Ocidental, Hosp Santa Cruz, Cardiol Dept, Lisbon, Portugal
[2] Ctr Hosp Lisboa Cent, EPE, Hosp Santa Marta, Dept Med 4,Arterial Invest Unit, Rua Santa Marta, P-11691024 Lisbon, Portugal
关键词
DENSITY-LIPOPROTEIN CHOLESTEROL; ACUTE CORONARY SYNDROME; PERSISTENT LIPID ABNORMALITIES; LOWERING LDL CHOLESTEROL; STATIN THERAPY; CARDIOVASCULAR RISK; IMPROVE-IT; HEART-DISEASE; HYPERCHOLESTEROLEMIC PATIENTS; ESC/EAS GUIDELINES;
D O I
10.1007/s40256-016-0205-0
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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.
引用
收藏
页码:169 / 181
页数:13
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