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

Am J Cardiovasc Drugs. 2017 Jun;17(3):169-181. doi: 10.1007/s40256-016-0205-0.

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.

Publication types

  • Review

MeSH terms

  • Anticholesteremic Agents / administration & dosage*
  • Atorvastatin / administration & dosage*
  • Cholesterol, HDL / blood
  • Cholesterol, LDL / blood
  • Drug Therapy, Combination / methods
  • Ezetimibe / administration & dosage*
  • Humans
  • Hyperlipidemias / blood
  • Hyperlipidemias / drug therapy*
  • Simvastatin / administration & dosage

Substances

  • Anticholesteremic Agents
  • Cholesterol, HDL
  • Cholesterol, LDL
  • Atorvastatin
  • Simvastatin
  • Ezetimibe