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

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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.

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  1. Cardiology Department, Hospital Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal

    António Miguel Ferreira

  2. 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 Marques da Silva

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AMF served as a part-time consultant for MSD Portugal, a subsidiary of Merck & Co., Inc. PMS has received lecture honoraria or consulting fees from Bayer, JABA-Recordati, Merck Sharp Dohme Portugal, Kowa Pharmaceuticals, Novartis, Daiichi Sankyo, Amgen, Sanofi-Regeneron, and Tecnimede.

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Ferreira, A.M., Marques da Silva, P. Defining the Place of Ezetimibe/Atorvastatin in the Management of Hyperlipidemia. Am J Cardiovasc Drugs 17, 169–181 (2017). https://doi.org/10.1007/s40256-016-0205-0

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