Lower-Intensity Statin Combo Therapy Bests High-Dose Monotherapy for LDL — But So What?

By Amy Orciari Herman

Combination therapy with a lower-dose statin plus either a bile acid sequestrant or ezetimibe reduces LDL cholesterol better than high-dose statin monotherapy, but long-term clinical benefits remain uncertain, according to a systematic review in the Annals of Internal Medicine.

Researchers examined data from 36 randomized, controlled trials of statin therapy among high-risk adults.

A low-intensity statin, combined with a bile acid sequestrant, lowered LDL cholesterol 0%-14% more than moderate-intensity statin monotherapy. In addition, a moderate-intensity statin plus ezetimibe conferred greater LDL reductions than high-dose monotherapy among those with preexisting cardiovascular disease or diabetes. However, data were insufficient to determine whether these changes in LDL translated to reductions in rates of death, atherosclerotic cardiovascular disease, or revascularization procedures.

Asked to comment, cardiologist Harlan Krumholz of NEJM Journal Watch wrote: "This study seems a little off-note, given that the new guidelines have moved us away from lipid targets. It is far from clear that this approach will improve outcomes, which is what patients care about."