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Cholesterol: a new drug combination brings no proven clinical benefit but an additional risk

In cardiovascular prevention, simvastatin is a first-line cholesterol-lowering drug. The combination of ezetimibe and simvastatin has no proven additional clinical benefit, but carries an increased risk of muscular damage.

The cholesterol-lowering drug simvastatin has been proved to be effective in reducing morbimortality in cardiovascular prevention.

The many trials with simvastatin + ezetimibe fail to show whether this combination results in a further drop in the number of cardiovascular events and the mortality rate. On the other hand, it is proven that ezetimibe increases the risk of muscular damage already observed with simvastatin.

In practice, when the treatment is being taken regularly and the effect of a first statin seems insufficient to lower cholesterol levels, the doctor should see whether another statin or a higher dosage are more effective. If a combination drug is envisaged, gemfibrozil or colestyramine have a proven clinical effectiveness and are therefore preferable to ezetimibe. But these combinations require close monitoring due to the increased muscular risks.

©Prescrire October 2006

Source: "Simvastatine + ézétimibe (Inegy°). Une association sans intérêt établi pour les patients" Rev Prescrire 2006 ; 26 (276) : 651.

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