New approaches to the management of dyslipidaemia

Multiple randomised controlled trials have unequivocally shown that lowering low-density lipoprotein cholesterol (LDL-C) results in a predictable reduction of coronary events and it appears that there is no threshold beyond which lowering LDL-C does not result in further benefit.
Although statins are the mainstay of treating hyperlipidaemia, they cannot always succeed in achieving more stringent lipid targets in some patients as they inhibit only one element of cholesterol homeostasis: the endogenous pathway. Ezetimibe is a novel agent which inhibits the exogenous cholesterol pathway, with resultant complementary benefits with statins.
Ezetimibe co-administered with a statin may provide an additional 16–18% reduction in LDL-C, compared to only a 6% further reduction in LDL-C with each doubling of a statin dose. This concept of combination therapy, tackling different homeostatic pathways, may be akin to strategies used in management of hypertension, where a combination of antihypertensive agents from different pharmacological classes is the norm.