Lipid Management with Ezetimibe and Atorvastatin

Introduction to Combination Therapy

The American College of Cardiology recommends using ezetimibe as an adjunct to statin therapy for patients who cannot achieve their LDL-C targets with statin monotherapy alone 1, 2, 3
Ezetimibe is FDA-approved for use in combination with statins to reduce total cholesterol, LDL-C, apolipoprotein B, and non-HDL-C in patients with primary hyperlipidemia 1
When added to statin therapy, ezetimibe provides an additional 25% reduction in LDL-C beyond what statins alone can achieve 1

The European Society of Cardiology guidelines recommend combination therapy with ezetimibe for patients who do not reach their LDL-C targets with maximally tolerated statin therapy (Class I, Level B recommendation) 4
High-risk patients with atherosclerotic disease who need to reach an LDL-C target of <1.8 mmol/L (70 mg/dL) may benefit from combination therapy 2
Patients with very high baseline LDL-C levels may be started on combination therapy upfront 3
The International Lipid Expert Panel recommends starting combination therapy immediately for patients with very high baseline LDL-C levels 3

For patients after myocardial infarction, guidelines recommend adding ezetimibe if LDL-C remains above target after 4-6 weeks of statin therapy 3
The American College of Cardiology guidelines support using ezetimibe as an adjunct to statin therapy for patients who cannot achieve their LDL-C targets with statin monotherapy alone 1

Monitor hepatic transaminases before and during treatment based on monitoring recommendations for statin therapy 1
Check lipid levels 4-6 weeks after initiation to assess efficacy, although the exact citation for this is not provided, it is implied by the context of treatment initiation and monitoring 1