[Role of statin/ezetimibe fixed-dose combination in lipid risk management in the cardiovascular disease continuum]

Prolonged exposure to high LDL cholesterol (LDL-C) levels represents a time-dependent driver of atherosclerotic risk. Available evidence shows that maintaining low LDL-C levels over time is associated with a reduction in cardiovascular events both in primary and secondary prevention. In this setting, combination therapy with statin and ezetimibe allows for a more effective LDL-C reduction compared with the statin titration alone, thanks to the complementary mechanism of action of the two drugs and improved treatment adherence. Clinical studies have demonstrated that early initiation of combination therapy increases the likelihood of achieving LDL-C goals and of reducing cardiovascular events. In parallel, recent real-world evidence downplays the incidence of complete statin intolerance, suggesting that a significant proportion of reported symptoms is attributable to nocebo effects. Therefore, the fixed-dose statin/ezetimibe combination represents an effective, simple, and generally well-tolerated therapeutic strategy to optimize lipid control. In patients requiring pronounced LDL-C reductions, combination with high-intensity statins contributes to achieving therapeutic goals while limiting the use of more complex and expensive injectable therapies.