Combination therapy of dyslipidemia

Clinical trials have demonstrated the benefit of low-density lipoprotein (LDL) cholesterol reduction and, with less robust evidence, reduction of triglyceride levels and increased high-density lipoprotein (HDL) cholesterol in the prevention of atherosclerotic cardiovascular disease. Although the statins are the cornerstone of lipid-lowering therapy, they may not be adequate to accomplish all of the changes in lipid and lipoprotein levels called for in current guidelines. Combinations of one or more lipid-modifying drugs in addition to lifestyle changes are now part of clinical guidelines and are being used extensively in practice. Clinicians need to be familiar with the individual drugs and how they interact. There is also a need for outcome data with combination therapy, especially for statin-fibrate and statin-niacin combinations. Several clinical trials are underway and should provide further evidence for the benefit of combination therapy of dyslipidemia. New drug classes have the potential to provide additive effects with currently available medications to provide substantial LDL reduction and increased HDL level that may lead to a substantial reduction in the burden of atherosclerotic vascular disease.