A total of 14 studies (11 randomized controlled trials and 3 cohort studies) with 108,373 very high-risk patients were included in the final analysis. The mean age of the patients in the combination LLT group and the statin monotherapy group was 67 years.
Combination LLT significantly more effectively reduced the LDL-C level from baseline (−13 mg/dL).
In addition, combination LLT significantly reduced all-cause mortality (by 19%), major adverse cardiovascular events (by 18%), and stroke incidence (by 17%), with an insignificant effect on cardiovascular mortality (by 14%) when compared with statin monotherapy.
The risk of adverse events and the therapy discontinuation rate were comparable between groups.
CONCLUSIONS
I have spent the last decade convincing patients who often did not want any Rx medication for their LDL-C to take 2 medications, not just one. Now, their is even more data that the approach at the KAHN CENTER has been on target.
Combination LLT was associated with an overall greater reduction in LDL-C, the same risk of adverse effects, and significantly lower risk of all-cause mortality, major adverse cardiovascular events, and stroke compared with statin monotherapy.
Forthcoming guidelines should consider the lipid-lowering combination therapy as early as possible, preferably up-front, for more effective LDL-C goal achievement and significant reduction of cardiovascular disease outcomes and mortality in high- and very high-risk patients.
One of the authors stated:
"This study confirms that combined cholesterol-lowering therapy should be considered immediately and should be the gold standard for treatment of very high-risk patients after an acute cardiovascular event.
"Simply adding ezetimibe to statin therapy, without waiting for at least two months to see the effects of statin monotherapy, which is suboptimal in many patients, is associated with more effective LDL-C goal achievement and is responsible for significant incremental reductions in cardiovascular health problems and deaths".
