The role of atorvastatin and ezetimibe in contemporary lipid-lowering therapy - time for combination treatment

Hypercholesterolaemia is the most common cardiovascular risk factor in Poland. The benefits of intensive cholesterol lowering in both primary and secondary prevention have been clearly demonstrated in many clinical trials. Statins are drugs of choice and should be used in the highest recommended or tolerated dose in order to achieve therapeutic goals. Unfortunately, the success rates in achieving therapeutic goals in dyslipidaemia are still low in Poland, which, according to experts, is associated with low statin doses, the choice of drugs with low lipid-lowering activity, short treatment duration, unjustified treatment cessation, and the limited use of combination therapy. Numerous studies have shown that combining ezetimibe with any statin is associated with greater reduction of LDL cholesterol and more frequent achievement of lipid targets compared to statin monotherapy. Ezetimibe monotherapy should be used in patients with statin intolerance or contraindications to its use. Therapy with statin and ezetimibe should also be considered in patients at increased risk of adverse effects of statins (e.g. the elderly, patients with impaired liver or kidney function, with previous side effects of statins or with possibility of interactions). This paper presents the potential position of atorvastatin and ezetimibe in contemporary lipid-lowering therapy, with particular emphasis on the effectiveness and safety of its use.