Lower-intensity statin combination therapy may utilize for high-risk atherosclerotic cardiovascular disease

For atherosclerotic cardiovascular disease risk reduction, American College of Cardiology and the American Heart Association guidelines recommend initiating moderate or high-intensity statin monotherapy as the first-line strategy. But some patients do not tolerate or respond to high-intensity statin monotherapy due to adverse effects or those who have limited LDL cholesterol response. Adverse effects are more common with higher-intensity statin regimens, and musculoskeletal adverse events occur frequently among patients with the C variant in the SLCO1B1 gene. Pharmacogenetic variability may also decrease statin efficacy.

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Dr. Gudzune and team compare the effectiveness, safety, and tolerability of moderated combination therapy of statin with another lipid-modifying medication (bile acid sequestrant, ezetimibe, fibrate, niacin, or ω-3 fatty acid) with those of higher-intensity statin monotherapy among high-risk patients. The results after study suggest that moderated statin combination therapy with bile acid sequestrants and combination of ezetimibe and lower-intensity statin decreases LDL cholesterol to a similar or greater extent compared with higher-intensity statin monotherapy among patients at high risk for atherosclerotic cardiovascular disease. They noted insufficient evidence regarding LDL cholesterol reduction when comparing moderated combination therapy with fibrates, niacin, or ω-3 fatty acids to higher-intensity statin monotherapy.

Though they notified that this strategy should be used with caution due to lack of evidence on long-term clinical benefits and harms.

This study was first published in Annals of Internal Medicine on 11th February 2014, doi:10.7326/M13-2526. The whole study was funded by the Agency for Healthcare Research and Quality.

Source: Annals of Internal Medicine