[First-line treatment of hypercholesterolemia : start with statin monotherapy or ezetimibe-statin combination ?]

Area of Science:

• Cardiology
• Pharmacology

Context:

• Hypercholesterolemia, particularly elevated Low-Density-Lipoprotein Cholesterol (LDL-C), is a primary risk factor for cardiovascular disease (CVD), including coronary artery disease.
• Current guidelines emphasize aggressive LDL-C reduction (≥50% from baseline) for high-risk individuals, especially in secondary prevention settings.

Purpose:

• To review the dual mechanisms of action for ezetimibe and statins.
• To summarize clinical evidence on the cholesterol-lowering efficacy and cardiovascular event reduction associated with ezetimibe-statin combination therapy.
• To outline the recommended positioning of this combination therapy within international guidelines and highlight available pharmaceutical formulations.

Summary:

• Ezetimibe and statins exert complementary actions to achieve significant reductions in LDL-C.
• Clinical trials and real-world studies demonstrate that ezetimibe-statin combination therapy not only lowers cholesterol effectively but also reduces cardiovascular events.
• This combination therapy is increasingly recognized in international guidelines for managing high-risk patients.

Impact:

• Provides clinicians with a comprehensive overview of ezetimibe-statin therapy for optimizing cardiovascular risk management.
• Supports the achievement of guideline-recommended LDL-C targets, thereby potentially decreasing the incidence of major adverse cardiovascular events.
• Facilitates informed prescribing decisions by detailing the evidence base and available treatment options.