Combination therapy for dyslipidemia.

PURPOSE OF REVIEW

Residual cardiovascular risk remains in individuals treated with statins and combination therapies may reduce this risk further.

RECENT FINDINGS

Most previous trials of combination therapies have shown a favorable effect on lipid profiles without clinical superiority over statin monotherapy. Trial design has been hampered by short duration and comparison with a low dose statin. The Study of Heart and Renal Protection trial has recently reported findings and shows a benefit of ezetimibe/simvastatin over simvastatin alone. AIM-HIGH (Atherothrombosis Intervention in Metabolic syndrome with Low HDL/High Triglycerides and Impact on Global Health Outcomes), a trial of statin/niacin, has been prematurely halted for futility. Finally, combining a statin with both niacin and ezetimibe shows significant enhancement of the therapeutic effect on lipid profiles.

SUMMARY

Current evidence continues to support initiation of a potent statin with titration to achieve targets. Combinations may be useful in individuals unable to reach desired lipid levels on maximal tolerated doses of statins.