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Dr Denke is on the advisory board of Merck/Schering–Plough Pharmaceuticals and on the speakers bureau for Merck & Co and Merck/Schering–Plough Pharmaceuticals. She also is an adviser and a coauthor on the Ezetimibe Add-on to Statin for Effectiveness (EASE) trial.

Address correspondence to Margo A. Denke, MD, FACP, FACE, Clinical Professor, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78284.Email: mdenke{at}ktc.com

Statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors) are the drug of first choice for lowering low-density lipoprotein cholesterol (LDL-C) levels and reducing risk of coronary heart disease (CHD). Current therapeutic use of statins, however, has resulted in only a small percentage of patients reaching their LDL-C treatment goal. Despite the clinical trial data supporting early aggressive use of statins, prescribing physicians are more likely to use lower doses of statins, leaving many patients at high risk of CHD short of goals. The barrier to achieving cholesterol treatment goals does not appear to be the decision to initiate statin therapy, but the failure of prescribers to titrate statin therapy to a dose sufficient to achieve goals.

An alternative to statin monotherapy is coadministration of a statin and a second agent that has a different mechanism of action. This approach can increase the likelihood of achieving target lipid levels and may be more acceptable to physicians. The coadministration of ezetimibe and simvastatin reduces cholesterol derived from both endogenous and exogenous sources. Simvastatin reduces the hepatic production of cholesterol, and ezetimibe decreases the intestinal absorption of dietary and biliary free cholesterol. The coadministration of low doses of these agents has been proved to be as effective as high-dose statin therapy in reducing LDL-C levels and assisting patients achieve their treatment goals.

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				K. A. Spratt and M. A. Denke Utility of Currently Available Modes of Therapy in Reaching Lipid Goals J Am Osteopath Assoc, September 1, 2004; 104(9_suppl): 14S - 16S. [Abstract] [Full Text] [PDF]