Combination regimens with statin, niacin, and intestinally active LDL-lowering drugs: alternatives to high-dose statin therapy?

Current Opinion in Lipidology
John R Guyton

Abstract

To summarize recent studies on combination regimens that employ a statin with added niacin, ezetimibe, and/or bile acid sequestrants, and to understand the implications of these studies for clinical practice. Combinations of statin, niacin, and/or intestinally active LDL-lowering drug have demonstrated safety and favorable effects on plasma low and high-density lipoproteins. Niacin and bile acid sequestrants appear to exert beneficial effects on atherosclerotic lesions, whereas results with ezetimibe are uncertain. Moreover, the use of niacin and bile acid sequestrants is supported by clinical outcome results from large monotherapy trials and small combination therapy trials. Three large randomized trials currently are evaluating clinical outcomes with the addition of niacin or ezetimibe to statin treatment. Until the results of ongoing trials are known, it is reasonable to favor the use of niacin and bile acid sequestrants in combination with statins, based on safety and efficacy with regard to effects on lipoproteins, atherosclerotic lesions, and, to a limited extent, clinical outcomes. The effect of ezetimibe on carotid atherosclerosis is indeterminate, but ezetimibe can be reasonably added to statin therapy as a secondary o...Continue Reading

References

Jan 27, 1975·JAMA : the Journal of the American Medical Association
Dec 19, 1990·JAMA : the Journal of the American Medical Association·J P KaneR J Havel
Dec 1, 1986·Journal of the American College of Cardiology·P L CannerW Friedewald
Oct 1, 1995·European Heart Journal·W F Armstrong
Jan 5, 2002·The New England Journal of Medicine·B G BrownJ J Albers
Oct 2, 2002·Annals of Internal Medicine·Paul S PhillipsUNKNOWN Scripps Mercy Clinical Research Center
Mar 10, 2004·The New England Journal of Medicine·Christopher P CannonUNKNOWN Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis in Myocardial Infarction 22 Investigators
Sep 1, 2004·JAMA : the Journal of the American Medical Association·James A de LemosUNKNOWN Investigators
Mar 10, 2005·The New England Journal of Medicine·John C LaRosaUNKNOWN Treating to New Targets (TNT) Investigators
Jul 22, 2005·The New England Journal of Medicine·Christoph WannerUNKNOWN German Diabetes and Dialysis Study Investigators
Nov 16, 2005·Journal of the American College of Cardiology·Jennifer G RobinsonHelmut Schrott
Nov 17, 2005·JAMA : the Journal of the American Medical Association·Terje R PedersenUNKNOWN Incremental Decrease in End Points Through Aggressive Lipid Lowering (IDEAL) Study Group
Apr 12, 2006·Archives of Internal Medicine·J David CurbFrits R Rosendaal
Aug 11, 2006·The New England Journal of Medicine·Pierre AmarencoUNKNOWN Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Investigators
Mar 27, 2007·JAMA : the Journal of the American Medical Association·John R CrouseUNKNOWN METEOR Study Group
Jul 11, 2007·Current Opinion in Lipidology·John R Guyton
Nov 7, 2007·The New England Journal of Medicine·Philip J BarterUNKNOWN ILLUMINATE Investigators
Nov 7, 2007·The New England Journal of Medicine·John KjekshusUNKNOWN CORONA Group
Apr 1, 2008·The New England Journal of Medicine·John J P KasteleinUNKNOWN ENHANCE Investigators
Apr 10, 2008·JAMA : the Journal of the American Medical Association·Barbara V HowardJianhui Zhu
Nov 11, 2008·The New England Journal of Medicine·Paul M RidkerUNKNOWN JUPITER Study Group
Apr 1, 2009·The New England Journal of Medicine·Bengt C FellströmUNKNOWN AURORA Study Group
Nov 17, 2009·The New England Journal of Medicine·Allen J TaylorMark Turco

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Citations

Aug 23, 2012·Vascular Health and Risk Management·Binh An P PhanPeter P Toth
Jan 8, 2014·Current Atherosclerosis Reports·John C LaRosa
May 15, 2013·Current Cardiology Reports·Peter O Kwiterovich
Jul 17, 2020·Cardiology Research and Practice·Akshyaya PradhanRishi Sethi
Dec 7, 2013·Expert Review of Clinical Pharmacology·John R GuytonWanda C Lakey

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