Effectiveness of Statins
The effectiveness of statins in the treatment and prevention of CHD is well-established.
With the statin doses used in most trials, LDL reduction was 25-35% and relative risk of CVD reduced by 24-37%. Risk reduction is observed irrespective of age, sex, history of CHD or other co-morbid conditions.
However, even when high statin doses (associated with an increase in liver complications and myopathy) are prescribed, good control of hypercholesterolaemia is not always achieved in clinical practice.
While statins are first-line therapy for lowering LDL-C3 a further agent may be added where they have failed to establish adequate blood lipid control.
Fibrates may be beneficial in patients with type 2 diabetes, high TG, low HDL-C or who are overweight.
Ezetimibe is a member of the drug class: intestinal cholesterol absorption inhibitors and can reduce LDL-C levels by a further 25% when added to existing statin therapy, compared to 4% reduction when placebo was added to existing therapy (p<0.001).
Studies have provided evidence for the safety profile of ezetimibe and that when used as dual therapy with statins it does not elevate the risk of muscle or hepatic damage.