Lowering
low-density lipoprotein cholesterol (
LDL-C) reduces the risk of
cardiovascular disease: each 1.0 mmol/L (38.7 mg/dL) reduction in
LDL-C reduces the incidence of major coronary events, coronary revascularizations, and
ischemic stroke by approximately 20%.
Statins are a well-established treatment option for
dyslipidemia, with
LDL-C reduction in the range of 27-55%. Several
lipid goal-driven guidelines recommend reducing
LDL-C to <2.59 mmol/L (100 mg/dL) or <1.81 mmol/L (70 mg/dL) in very high-risk patients. Many patients treated with
statins do not reach these goals, and remain at risk of future cardiovascular events. The 2013 American College of Cardiology/American Heart Association guidelines move away from advocating
LDL-C treatment targets with focus placed on identifying patients most likely to benefit from high-intensity or moderate-intensity
statin therapy. While increasing the
statin dose can prove efficacious in some patients, this approach typically offers limited additional
LDL-C lowering, and is associated with increased incidence of adverse side effects. Indeed, this has led to the investigation of
statins in combination with other
lipid-modifying agents for the treatment of
dyslipidemia. This review of the evidence for
statin use in combination with
fibrates,
niacin,
bile acid sequestrants, and the
cholesterol absorption inhibitor,
ezetimibe, in dyslipidemic patients at increased risk of
cardiovascular disease, explores the impact of such combination
therapies on
lipids, attainment of
lipid targets, inflammatory markers, and on cardiovascular outcomes and pathology. Additionally, new and emerging
dyslipidemia treatments are summarized.