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Ezetimibe may complement statins and other lipid-lowering drugs

Using the lipid-lowering drug ezetimibe (Zetia) in combination with statin drugs may help decrease the occurrence of adverse events seen with statin therapy, according to the conclusion of a review article.

Ezetimibe inhibits cholesterol absorption and has a favourable profile of adverse events. Unlike statins, the drug does not pose a risk of hepatotoxicity or myositis. And ezetimibe lowers low-density lipoprotein (LDL) levels by about 18% when used as monotherapy and by an additional 25% when added to statin therapy.

According to Ryan C. Neal, MD, Baylor College of Medicine, Houston, Texas, United States, and colleagues, most patients who should be on lipid-lowering therapy are not receiving it, and most patients who are receiving it are not reaching appropriate LDL goals, resulting in a treatment gap.

In their article, the authors cite data suggesting that less than 40% of patients with coronary heart disease may be on lipid-lowering therapy and only 25% may achieve a target level of below 100 mg/dL. Another study has found that 18% of CHD patients undergoing treatment achieve LDL levels below 100 mg/dL.

"This [low usage rate] is in part because physicians and patients fear side effects of statins and other lipid-lowering agents," Dr. Neil and colleagues write.

In cases where patients cannot tolerate maximum doses of statins or a combination of a statin plus a fibrate or niacin, clinicians may choose moderate-dose statin monotherapy or low-dose statin therapy plus an agent such as ezetimibe, which does not appear to increase the incidence of adverse events compared to placebo.

"In theory, the mechanism of action of ezetimibe should complement that of fibrates, niacin, and bile acid resins," they suggest. The most practical use of ezetimibe will be in combination with ongoing statin therapy in patients who have not reached their LDL goals, they add.
Cleve Clin J of Med 2003;70:9:777-783. "Lipid-lowering: Can ezetimibe help close the treatment gap?"

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