Combination Therapy for Lowering Cholesterol Not Yet Proven to Be Superior to Statins Alone
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Reviewed By Elizabeth Klodas, MD, FACC
More than 28 million Americans have some form of heart disease, and doctors often prescribe statin drugs to lower dangerous low-density lipoprotein (LDL) cholesterol levels. High LDL cholesterol levels increase the risk of arteries becoming blocked and triggering a heart attack or stroke.
Even so, researchers say only about one-third of people with high cholesterol are able to lower their LDL cholesterol to healthy levels and that number is even lower among those with established heart disease.
That prompts many doctors to try combining cholesterol-lowering statin therapy with other non-statin medications in an attempt to further lower cholesterol levels.
But researchers analyzed 102 published studies on the topic and found no benefit of combination therapy at reducing the risk of death, heart attack, stroke, or the need for bypass surgery over using high doses of statins alone.
The studies were of relatively short duration, often did not employ maximal doses of statin drugs in the combination regimens, and did not examine all possible medication combinations. These limitations affect the ability to make firm conclusions regarding the true use of combination therapy.
Nevertheless, the proven benefits of using statin drugs alone in reducing the risk of heart attack and stroke suggest that "the benefits of additional therapies need to be clearly defined along with attendant risks and costs before advocating widespread use of combination treatment," writes researcher Mukul Sharma, MD, MSc, of the Canadian Stroke Network in the Annals of Internal Medicine.
SOURCES: Sharma, M. Annals of Internal Medicine, Sept. 1, 2009; vol 151. News release, American College of Physicians.
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