Effectiveness and safety of combinational therapy compared with intensified statin monotherapy in patients with coronary heart disease

Reducing the plasma levels of low-density lipoprotein-cholesterol (LDL-C) is critical for patients with coronary heart disease (CHD). Conventional treatment with statins alone may not achieve the goal of lowering LDL-C due to drug intolerance or resistance. The present study evaluated the effectiveness and safety of combining statin with another lipid-lowering agent in the management of dyslipidemia in CHD patients. A total of 180 patients with CHD were divided into three therapeutic groups (n=60 in each): Statin/colesevelam group (20 mg atorvastatin and 10 mg colesevelam daily), statin/ezetimibe group (20 mg atorvastatin and 10 mg ezetimibe daily) and high-intensity statin monotherapy group (30 mg atorvastatin daily). The baseline plasma lipid levels were measured. The duration of the treatment was eight weeks and the side effects were noted at one year's follow-up. After eight weeks' treatment, the mean plasma level of LDL-C was reduced by 45.2, 44.8 and 30.0% in the statin/colesevelam, statin/ezetimibe and statin monotherapy group, respectively. The reduction of LDL-C in the combinational therapy groups was greater than that in the statin monotherapy group (P<0.05). The proportion of patients achieving the goal of lowering LDL-C in the combinational therapy groups was higher than that in the statin monotherapy group. The effectiveness of reducing lipids was similar in the two combinational statin/colesevelam and statin/ezetimibe groups. Rates of adverse events were not significantly different among the three groups. In conclusion, statins combined with colesevelam or ezetimibe were more effective in reducing plasma LDL-C levels than high-intensity statin monotherapy. This combinational therapeutic strategy may be an alternative for patients that are resistant or intolerant to statins.