Ezetimibe Added to Fenofibrate in Mixed Hyperlipidemia – ACC Consensus Recommendations

Indications and Patient Selection

• The 2022 American College of Cardiology (ACC) Expert Consensus acknowledges that ezetimibe is FDA‑approved for use in combination with fenofibrate to lower elevated LDL‑cholesterol in adults with mixed hyperlipidemia (elevated LDL‑C ≥ 160 mg/dL and triglycerides 150–405 mg/dL)【1】.
• According to the same ACC consensus, the combination should be considered when statin therapy is not tolerated, contraindicated, or insufficient as the primary LDL‑lowering strategy【1】.

Position Relative to Statin Therapy

• The 2018 AHA/ACC Guideline (cited in a 2019 ACC publication) states that maximally tolerated statin therapy remains first‑line for patients with established ASCVD or high cardiovascular risk; ezetimibe may be added to statins for further LDL‑C reduction, but the fenofibrate‑ezetimibe combination does not replace statin therapy in these high‑risk groups【2】.
• The ACC 2022 consensus further clarifies that the fenofibrate‑ezetimibe regimen is specifically indicated when statin‑based approaches are inadequate or not feasible for patients with mixed hyperlipidemia【1】.