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Combination therapy.

Margo A Denke1

  • 1University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd., Dallas, TX 75390, USA. Margo.Denke@UTSouthwestern.edu

Journal of Managed Care Pharmacy : JMCP
|November 14, 2003
PubMed
Summary

Achieving low-density lipoprotein cholesterol (LDL-C) targets is challenging for many patients with dyslipidemia. Combination therapies, including ezetimibe, show promise for improving LDL-C goal attainment in coronary heart disease (CHD) risk management.

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Area of Science:

  • Cardiology
  • Pharmacology
  • Metabolic Disorders

Background:

  • Adult Treatment Panel III (ATP III) guidelines set LDL-C targets based on individual coronary heart disease (CHD) risk.
  • Therapeutic lifestyle changes are foundational but often insufficient for achieving LDL-C goals.
  • Physician practice surveys indicate suboptimal achievement of LDL-C targets and underassessment of treatment candidates.

Purpose of the Study:

  • To review the pharmacotherapeutic effects of combination lipid-lowering therapies.
  • To summarize the efficacy and limitations of current drug combinations.
  • To evaluate the role of ezetimibe in the LDL-C treatment algorithm.

Main Methods:

  • Review of pharmacotherapeutic effects of combination therapy.
  • Summary of strengths and weaknesses of existing lipid-lowering drug combinations.
  • Identification of ezetimibe's potential contribution.

Main Results:

  • Most patients require pharmacotherapy beyond lifestyle modification to reach LDL-C goals.
  • Up-titration of statins or combination therapy can improve LDL-C lowering.
  • Combination therapies targeting both cholesterol synthesis pathways are particularly effective.

Conclusions:

  • Achieving target LDL-C levels remains a clinical challenge.
  • Combination therapies offer enhanced efficacy for lipid-lowering.
  • Ezetimibe represents a novel option to improve LDL-C goal attainment in dyslipidemia management.

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