Endocrinology Medical News about lipid-lowering agents; high-dose statin monotherapy

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Systematic Review: Comparative Effectiveness and Harms of Combinations of Lipid-Modifying Agents and High-Dose Statin Monotherapy
Annals of Internal Medicine, 09/01/09

Sharma M et al. – Limited evidence suggests that combinations of lipid–lowering agents do not improve clinical outcomes more than high–dose statin monotherapy. Very–low–quality evidence favors statin–ezetimibe treatment for attainment of low–density lipoprotein cholesterol goals. Methods

A reviewer screened records English–language records from MEDLINE (1966–2009), EMBASE (1980–2009), and the Cochrane Library (third quarter of 2008).
A second reviewer verified selection of randomized, controlled trials in adult patients that compared combinations of statins and bile–acid sequestrants, fibrates, ezetimibe, niacin, or omega–3 fatty acids with statin monotherapy, as well as nonrandomized comparative studies that were longer than 24 weeks and reported clinical and harms outcomes.
Data were abstracted for studies by using standardized forms, and study quality was rated with a standardized scale and strength of evidence by using the Grading of Recommendations Assessment, Development, and Evaluation approach.

Results

102 studies met eligibility criteria.
2 trials suggested lower target lipid levels were more often achieved with a statin–ezetimibe combination therapy than with high–dose statin monotherapy.
No firm trial evidence showed that combining a statin with another agent (bile–acid sequestrant, fibrate, ezetimibe, niacin, or omega–3 fatty acids) improved clinical outcomes (myocardial infarction, stroke, or mortality) more often than high–dose statin monotherapy.

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