The efficacy and safety of ezetimibe coadministered with statin therapy in various patient groups

摘要

Various guidelines for cholesterol management recognize LDL cholesterol (LDL?C) lowering as the primary target of lipid?lowering therapy (LLT) and statin therapy as an important approach to reducing LDL?C levels. Guidelines advocate more intensive statin therapy and/or combination therapy for higher?risk patients who do not achieve recommended LDL?C levels. However, many individuals do not attain guideline?recommended LDL?C levels, particularly those at higher cardiovascular risk. Response to and tolerability of LLT can also vary by patient characteristics, such as age, gender and race?related factors, as well as medical conditions including diabetes mellitus, metabolic syndrome, familial hypercholesterolemia, aortic valve stenosis and chronic kidney disease. Consideration of such characteristics is important in optimizing LLT for patients with these abnormalities. Coadministration of the cholesterol absorption inhibitor, ezetimibe, with statins improves LDL?C lowering, other lipid parameters and high?sensitivity CRP levels more than statins alone across diverse patient populations. The combination also reduces ischemic events in patients with chronic kidney disease and aortic valve stenosis. In clinical studies, ezetimibe plus statin therapy has been generally well tolerated in 22,000 patients during 6–24 weeks and in 11,000 patients in studies up to 4 years in duration. This article summarizes the treatment recommendations for subgroups at increased cardiovascular risk and reviews the available information relating to the efficacy and safety provided by ezetimibe in combination with statins in these and other specific patient subpopulations.