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A Clinical Guide to Combination Lipid-Lowering Therapy

  • Nonstatin Drugs (E. deGoma, Section Editor)
  • Published:
Current Atherosclerosis Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

We provide an overview of our current understanding of combination lipid-lowering therapies intended for dyslipidemia treatment and cardiovascular disease prevention. First, we analyze recent statin and non-statin combination therapy guidelines and clinical studies since the publication of 2013 American College of Cardiology Cholesterol Guidelines. Second, we examine the clinical utility of non-statin agents alone and in combination in terms of LDL-C lowering and ASCVD risk reduction.

Recent Findings

Medical societies, including the American College of Cardiology (ACC), National Lipid Association (NLA), and American Association of Clinical Endocrinologists (AACE), have released guidelines to address the appropriate use of non-statin therapies. The guidelines incorporated new evidence, including the IMPROVE-IT and FOURIER clinical trials, which demonstrate that the combination of statin therapy with other non-statin agents such as ezetimibe and PCSK9 inhibitors has a significant clinical benefit. Increasing evidence that aggressive low-density lipoprotein cholesterol (LDL-C) lowering leads to lower cardiovascular disease risk supports the need for continued exploration of the role of combination lipid-lowering therapies.

Summary

A review of guidelines and clinical trials evaluating non-statin agents illuminates the growing base of evidence and expert opinion supporting the use of combination lipid-lowering therapies. While the majority of clinical trial data utilizes dyslipidemia monotherapy, especially statins, combination therapies represent an opportunity for individualized, patient-centered approach to LDL-C lowering and atherosclerotic cardiovascular disease (ASCVD) risk reduction. The overview provides a perspective on lipid management intended for clinicians who seek additional information and guidance on the use of combination therapies.

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Author information

Authors and Affiliations

  1. Cardiovascular Division, Department of Medicine, University of Pennsylvania Health System, Philadelphia, PA, USA

    Cori Russell & Douglas Jacoby

  2. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Samip Sheth

  3. Penn Presbyterian Medical Center, Heart & Vascular Pavilion, 4th Floor, 51 N. 39th Street, Philadelphia, PA, 19104, USA

    Douglas Jacoby

Authors
  1. Cori Russell
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  2. Samip Sheth
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  3. Douglas Jacoby
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Corresponding author

Correspondence to Douglas Jacoby.

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Conflict of Interest

Cori Russell, Samip Sheth, and Douglas Jacoby declare no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Nonstatin Drugs

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Russell, C., Sheth, S. & Jacoby, D. A Clinical Guide to Combination Lipid-Lowering Therapy. Curr Atheroscler Rep 20, 19 (2018). https://doi.org/10.1007/s11883-018-0721-2

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  • DOI: https://doi.org/10.1007/s11883-018-0721-2

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