Similar trends were observed for changes in total cholesterol .
Implication sGiven the available data , the addition of ezetimibe to ongoing simvastatin , atorvastatin , or rosuvastatin monotherapy offers greater reduction in LDL-C among patients at high risk of CVD compared to doubling the initial statin dose
Purpose While statins are used as first-line treatments for high-risk patients with hypercholesterolemia , statin monotherapy is often insufficient to achieve target low-density lipoprotein cholesterol ( LDL-C ) levels .
Second-line treatment options include up-titration of statin dose , switching to a more potent statin , or combination therapy , e.g. , with ezetimibe .
The aim of this study was to evaluate the efficacy of adding ezetimibe to simvastatin , atorvastatin , or rosuvastatin monotherapy versus doubling the dosage or switching to a higher-potency statin in a population of patients with hypocholesterolemia at high risk of cardiovascular disease ( CVD ) and who had been previously treated with a statin .
Atorvastatin treatment and LDL cholesterol target attainment in patients at very high cardiovascular risk
The use of atorvastatin is rapidly increasing among statins since the introduction of generics . However , only limited data are available on its current use and the effectiveness outside of r and omised trials . The aim of the study was to assess low-density lipoprotein ( LDL-C ) levels in ambulatory patients at very high cardiovascular risk on atorvastatin therapy in physician ’s offices . A total of 2625 high-risk patients on atorvastatin were included into this cross-sectional study by 539 office-based physicians between June and December 2014 . 47.0 % of the patients had documented coronary heart disease ( CHD ) , 25.1 % type 2 diabetes mellitus ( DM ) , and 27.9 % CHD plus concomitant DM . The mean age was 66.1 ± 10.8 years , 62.1 % were male . Atorvastatin at the dose of 10 , 20 , 40 and 80 mg/day was administered in 15.6 , 45.7 , 33.9 , and 4.8 % of the patients , respectively . The treatment duration was 92.6 ± 109.6 weeks . The  mean atorvastatin dose at therapy start was 24.8 ± 15.2 mg/day and at time of documentation 27.9 ± 15.8 mg/day . Low-density lipoprotein cholesterol ( LDL-C ) < 70 mg/dL was achieved by 10.5 % of the total cohort ( 7.5 % in DM , 9.3 % in CHD , and 15.2 % in CHD + DM ) . In contrast , according to physicians ’ subjective assessment , 62.7 % of patients ( with small differences between groups ) had reached their individual LDL-C target . In summary , higher doses of atorvastatin are not frequently used in clinical practice . The LDL-C target level < 70 mg/dL as recommended by current guidelines is achieved only in a minority of atorvastatin treated patients at very high cardiovascular risk
Similar trends were observed for changes in total cholesterol .
Implication sGiven the available data , the addition of ezetimibe to ongoing simvastatin , atorvastatin , or rosuvastatin monotherapy offers greater reduction in LDL-C among patients at high risk of CVD compared to doubling the initial statin dose
Purpose While statins are used as first-line treatments for high-risk patients with hypercholesterolemia , statin monotherapy is often insufficient to achieve target low-density lipoprotein cholesterol ( LDL-C ) levels .
Second-line treatment options include up-titration of statin dose , switching to a more potent statin , or combination therapy , e.g. , with ezetimibe .
The aim of this study was to evaluate the efficacy of adding ezetimibe to simvastatin , atorvastatin , or rosuvastatin monotherapy versus doubling the dosage or switching to a higher-potency statin in a population of patients with hypocholesterolemia at high risk of cardiovascular disease ( CVD ) and who had been previously treated with a statin .