Combination therapy for dyslipidemia

PURPOSE OF REVIEW: Residual cardiovascular risk remains in individuals treated with statins and combination therapies may reduce this risk further. RECENT FINDINGS: Most previous trials of combination therapies have shown a favorable effect on lipid profiles without clinical superiority over statin monotherapy. Trial design has been hampered by short duration and comparison with a low dose statin. The Study of Heart and Renal Protection trial has recently reported findings and shows a benefit of ezetimibe/simvastatin over simvastatin alone. AIM-HIGH (Atherothrombosis Intervention in Metabolic syndrome with Low HDL/High Triglycerides and Impact on Global Health Outcomes), a trial of statin/niacin, has been prematurely halted for futility. Finally, combining a statin with both niacin and ezetimibe shows significant enhancement of the therapeutic effect on lipid profiles. SUMMARY: Current evidence continues to support initiation of a potent statin with titration to achieve targets. Combinations may be useful in individuals unable to reach desired lipid levels on maximal tolerated doses of statins.