Adding ezetimibe to statin treatment: is LDL-C lowering the only benefit?

Abstract

Arimura T, Miura S, Ike A et al. Comparison of the efficacy and safety of statin and statin/ezetimibe therapy after coronary stent implantation in patients with stable angina. J. Cardiol. 60(2), 111–118 (2012). Adding ezetimibe to low-dose statins can result in more high-risk patients (e.g., those with coronary heart disease) who achieve LDL cholesterol (LDL-C) goals compared with statin monotherapy (even after doubling the dose). However, it is uncertain whether this strategy results in slower atherosclerosis progression. In a recently published study, statin + ezetimibe combination lowered LDL-C levels more than statin monotherapy in patients with stable coronary heart disease. This incremental decrease was not associated with significant differences in in-stent restenosis or major clinical outcome rates. This article will discuss whether ezetimibe can add to the benefits of statins on atherosclerosis and cardiovascular risk reduction in relation to further LDL-C lowering and lipid-modifying properties, including triglyceride lowering and increased LDL particle size. In addition, the role of ezetimibe in preventing statin-related dose-dependent increases in the risk of muscle-related toxicity and new-onset diabetes is discussed.