Combination therapy in the management of complex dyslipidemias

Patients with dyslipidemias continue to be undertreated in both the primary and secondary prevention settings. Many patients have therapeutic needs that exceed simple reductions in low-density lipoprotein levels using statins. This review discusses the need for comprehensive management of all abnormalities in a given patient's lipoprotein profile and for the use of combinations of anti-lipidemic medications, when indicated.

The majority of high-risk patients with manifestations of atherosclerotic disease or who have a coronary artery disease risk equivalent are not meeting their various lipoprotein targets. There is considerable reluctance to titrate statins and to use combinations of anti-lipidemic medications in patients not reaching their various lipoprotein targets. Combinations of anti-lipidemic medications can be specifically tailored to address abnormalities in multiple lipoprotein fractions. Recent clinical trials clearly demonstrate that combination therapy is well tolerated and facilitates lipoprotein goal attainment.

Therapeutic approaches that incorporate the use of multiple anti-lipidemic medications should be more widely adopted in order to increase the number of patients able to meet their lipoprotein goals and to produce more substantially reduced risks for acute cardiovascular events.