Combined lipid-lowering therapy: choosing strategy and tactics

Achieving target levels of low-density lipoprotein cholesterol (LDL-CH) with lipid-lowering therapy is the main component of the complex cardiovascular risk reduction, according to the Russian and international clinical guidelines. High-density lipoprotein cholesterol and triglycerides are regarded as secondary targets for lipid-lowering therapy. High-dose statin monotherapy and combined therapy could achieve target LDL-CH levels only in 30-50 %. The available evidence demonstrates that to achieve target LDL-CH levels more effectively, statin should be combined with other lipid-lowering drugs, or fixed-dose combined lipid-lowering therapy should be prescribed. In particular, the maximal LDL-CH reduction is achieved when statin is combined with ezetimibe, or when the fixed-dose combination (simvastatin 20 mg and ezetimibe 10 mg) is used. Specific aspects of combined lipid-lowering therapy in various clinical situations are discussed, in accordance with current clinical guidelines. To improve lipid-lowering therapy compliance, patients should be involved into assessing their cardiovascular risk and discussing potential ways of risk reduction.