Statin Plus Ezetimibe as Fixed-Dose Combination for LDL-C Reduction in High-Risk Patients

General practitioner checks cholesterol levels in patient test results on blood lipids. Statin pills, stethoscope, cholesterol test and hand of doctor, pointing to increasing its level in concept
A combination of statin and ezetimibe vs statin alone was found to further reduce levels of LDL-C in patients at very high cardiovascular risk.

A combination of statin and ezetimibe vs statin alone was found to further reduce levels of low-density lipoprotein cholesterol (LDL-C), particularly as a fixed-dose combination (FDC), in patients at very high cardiovascular risk, according to a study published in Clinical Research in Cardiology.

In this retrospective analysis, the data of outpatients in Germany considered to be at very high cardiovascular risk who were treated by general practitioners (GPs) or cardiologists between 2013 and 2018 and prescribed lipid-lowering therapies (LLT) were examined. From the total population of 646,826 patients, 311,242 were included in the final analyses. Of patients prescribed LLTs in 2018, 97.2% were treated by GPs and 2.8% by cardiologists. The mean age was 71.4 years (58.8% men) for patients treated by GPs and 69.1 years (74.6% men) for those treated by cardiologists.

High-potency statins (ie, atorvastatin and rosuvastatin) were prescribed to 10.4% and 25.8% of patients treated by GPs and cardiologists, respectively, in 2013, and to 34.7% and 58.3% of patients treated by GPs and cardiologists, respectively, in 2018. Prescriptions for nonstatin LLTs remained low and stable between 2013 and 2018, especially for GPs. Ezetimibe was the most prescribed nonstatin LLT in 2018 (GPs, 76.1%; cardiologists, 92.8%).

The addition of ezetimibe to statin vs statin alone was found to reduce LDL-C levels by an additional 23.8% (reduction, 32.3±38.4 mg/dL), with a greater reduction with FDC (reduction, 28.4%; 40.0±39.1 mg/dL) compared with separate pills (reduction, 19.4%; 27.5±33.8 mg/dL; P <.0001). A small percentage of patients achieved the recommended LDL-C level (ie, <70 mg/dL; 31.5% with FDC; 21.0% with separate pills).Study limitations include the lack of data on medication adherence, and the reasons for prescribing FDC vs separate pill combinations.

“Our study shows the potential of lipid-lowering combination therapy and suggests that, similar to current recommendations for anti-hypertensive treatment, FDC prescription should be preferred over separate pill combinations,” noted the study authors.

“These data identify practical strategies to improve LDL-C goal achievement for [atherosclerotic cardiovascular disease] prevention. However, a high proportion of patients remain with uncontrolled LDL-C despite the combination of oral LLT.”

Disclosures: Some of the authors declared affiliations with pharmaceutical and biotechnology companies. Please see the original reference for a full list of disclosures.


Katzmann JL, Sorio‑Vilela F, Dornstauder E, et al. Non‑statin lipid‑lowering therapy over time in very‑high‑risk patients: Effectiveness of fixed‑dose statin/ezetimibe compared to separate pill combination on LDL‑C. [published online September 19, 2020]. Clin Res Cardiol. doi: 10.1007/s00392-020-01740-8