Department of Medicine (DIMED), University of Padova, Via Giustiniani 2, 35128, Padua, Italy.
Veneto Institute of Molecular Medicine (VIMM), Via Orus 2, 35129, Padua, Italy.
Curr Atheroscler Rep. 2023 Oct;25(10):691-699. doi: 10.1007/s11883-023-01142-x. Epub 2023 Sep 16.
It is clear from epidemiological studies that patients at high and very-high risk of atherosclerotic cardiovascular diseases (ASCVD) risk do not reach lipid guideline-recommended targets. Thus, fixed-dose combinations of statins/ezetimibe, bempedoic acid/ezetimibe and statins/fibrates may represent a further armamentarium in the field of lipid-lowering approaches in these individuals.
The combination therapy of moderate-intensity statin with ezetimibe is not inferior to high-intensity statin monotherapy in reducing cardiovascular outcomes. Drug discontinuation or dose reduction is inferior with fixed-dose combination. The fixed-dose combination of bempedoic acid with ezetimibe is superior to bempedoic acid in monotherapy in lowering LDL-C and in reducing high-sensitivity C-reactive protein concentrations. The combination fenofibrate with atorvastatin is superior to monotherapies in lowering triglycerides. Lipid-lowering fixed-dose combinations may guarantee a higher therapy adherence, representing a better approach to control plasma lipids and thus ameliorate ASCVD burden. Additional studies will define the advantages on cardiovascular outcomes in high and very high-risk patients.
流行病学研究清楚表明，患有高和极高动脉粥样硬化性心血管疾病（ASCVD）风险的患者无法达到血脂指南推荐的目标。因此，他汀类药物/依折麦布、贝匹酸/依折麦布和他汀类药物/贝特类药物的固定剂量组合可能是这些患者降脂方法领域的另一种手段。
中等强度他汀类药物联合依折麦布的联合治疗在降低心血管结局方面并不逊于高强度他汀类药物单药治疗。固定剂量组合的药物停药或剂量减少不如固定剂量组合。贝匹酸与依折麦布的固定剂量组合在降低 LDL-C 和降低高敏 C 反应蛋白浓度方面优于贝匹酸单药治疗。非诺贝特与阿托伐他汀的联合治疗在降低甘油三酯方面优于单药治疗。降脂固定剂量组合可能保证更高的治疗依从性，代表了控制血浆脂质的更好方法，从而改善 ASCVD 负担。进一步的研究将确定在高和极高风险患者中对心血管结局的优势。
