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Am J Cardiol. 2009 Sep 15;104(6):798-804. doi: 10.1016/j.amjcard.2009.05.019. Epub 2009 Jul 23.

Usefulness of statin-ezetimibe combination to reduce the care gap in dyslipidemia management in patients with a high risk of atherosclerotic disease.

Collaborators (267)

Chen RY, Burlacoff S, Tjia S, Jaffer S, Katsuno RM, Legault D, Theriault L, Lynch M, Serfaty S, Del Vecchio E, Seaman JG, Rovers K, Ho-Asjoe MP, Ng KH, Tham PL, Gotaul P, Hartford B, Plourde S, Martinho V, Bukovy BE, Yee G, Roberts BC, Mehta PG, Da Silva L, Sousa N, Brouillette G, Sinnaeve LJ, Luces KF, Luces D, Zavodni LS, Emond S, Lam YM, Tung TH, Luftspring L, Nofiel G, Duckett J, Sasseville R, Ciricillo D, Arruda A, Khotianov N, Ramgoolam R, Moulton WB, Shih C, Desario S, She A, Andrew CV, Kopyto AA, Lavoie N, Kiai C, Wong WT, Kazimirski M, Gibbons L, Kalra BB, Gotesman G, Noronha OI, Wawer AR, Laporte H, Chan DY, Chang GN, Forbes FB, Browne NJ, Grant S, Hill L, Faul J, Studniberg A, Mehan UK, Collette RS, Racanelli O, Park D, Cormack M, Foo MC, Lin B, Côte R, Bunn RC, Theodoropoulos I, Greenwald KJ, Hong T, Hong S, McQueen KR, Horner RH, Szajkowski S, McComiskey AJ, Davies EG, Jacyk P, Lam AW, Lau MJ, Milio HS, Pang PK, Phillips KM, Campbell C, Leung BP, Tse WK, Luton RG, Dauglass S, Lipsett WG, Lombard SJ, Patel IM, Girard JB, Guite C, Racine R, Goyer R, Veilleux R, Babick TR, Baran G, Chan Y, Cho K, Cram DH, Kowalchuk R, Desroches J, Epstein R, Fruchtermann LP, Del Vecchio E, Lee OI, Carcasole F, Chehayeb R, Loranger B, Liboiron P, Beauchamp L, Patel J, Bautista E, Wong D, Bender JD, Majid FS, Waite C, Mckinnon D, Cunningham WL, Nowlan M, Roy G, Subramanian T, Selhi BD, Symington DJ, Vermeulen A, Fay DF, Kielty JF, Sidhu T, Zaphiratos T, Gagnon R, Labbe M, Roy B, Jean N, Dyck GH, Hildebrand J, Patel RC, Chaulk DR, Shaw E, Conway JR, Patasi B, Levy ME, Sochocka EK, Rossman LH, Dubin RE, Lebel M, Toussaint M, Baria N, Gaudreau G, Woo V, Clark C, Cox VH, Cox RH, Bryant L, Stimatz L, Rosenthall W, Charbonneau J, Mynhardt HD, Balkissoon M, Kandasamy GR, Kates ML, Naimi H, Ouimet A, Roberge G, Bowler B, Lynagh NJ, Nguyen HH, Fortier D, Oudar V, Lipinski GB, Allison RC, Awrey WR, Robert MA, Frenett B, Cook AF, Ismail SH, Poisson A, Patel PC, Bautista E, Meneses G, Schwartz E, Ezekiel D, Mercier C, Lopez E, Woodland KH, Kim JS, Wedgewood H, Fung ML, Forrest D, Bhatt GS, Mccullough D, Ying JJ, Norton V, Girard JB, Laliberte A, Kachan PS, Sutherland JG, Elliott CR, Dudley EM, Genge RJ, Abramson N, Wright C, Salmaniw WR, Wurtele P, Nirwan A, Berjat MB, St Pierre B, Lachance C, Fontaine RJ, Morgan C, Beeston W, Lillie E, Patel SV, Ciomyk RI, Lee-Cheong NL, Faiers A, Chung CK, MacDonald J, Thiessen N, Retanal VL, Sinclair D, Nault Y, Bridger IM, James J, Marsh DW, Sanchez ZA, Phelan P, Avinashi RK, Frenette B, Johnson M, Dang BT, Dang M, Leung HK, Nagaria N, Ross D, Bouthillier J, Mikhail AS, Tremblay A, Casserly JG, Casserly P, Sumaira WS, Chan J, Ng L, Wu CY, Bouchard C, Pham GT, Sohal PS, Wong BL, Sikhakhane AM, Sewchand LS, Osborne EJ, Mazhar MM, De Beaumont JR, Bereznay OH, Cordoni T, Silver S, Skidmore P, Seward G, Hillman AJ, Kooy J, Ouellet E.

Author information

Division of Cardiac Surgery, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.


Lowering of low-density lipoprotein (LDL) cholesterol is a fundamental step in the comprehensive management of patients at high risk for cardiovascular events. The combination of a statin with ezetimibe usually provides additional LDL cholesterol lowering compared to statin monotherapy. This open-label observational study evaluated the impact of a 26-week treatment program with uptitration of statin dosages and incorporation of ezetimibe 10 mg therapy in 2,577 men and women (median age 64 years) with hypercholesterolemia and an LDL cholesterol level >2.5 mmol/L (97 mg/dl). Attainment of an LDL cholesterol target of 2.5 mmol/L (97 mg/dl) increased with consecutive visits (63%, 67%, and 71% at the second, third, and final visits, respectively). Current guideline-recommended LDL cholesterol value <2.0 mmol/L (77 mg/dl) was achieved by 36%, 40%, and 41% of the group at the same consecutive follow-up sessions. Median LDL cholesterol decreased from 3.0 mmol/L (116 mg/dl) at baseline to 2.1 mmol/L (81 mg/dl) at the end of the 26-week monitoring period. Favorable changes were concomitantly observed for median total cholesterol (5.1 to 4.1 mmol/L [197 to 159 mg/dl]), total cholesterol/high-density lipoprotein cholesterol ratio (4.2 to 3.3), and triglyceride (1.6 to 1.4 mmol/L [142 to 124 mg/dl]). Of those who attended visit 4, 48% exhibited LDL cholesterol lowering of > or =1 mmol/L (39 mg/dl) compared to baseline levels. In conclusion, an algorithm-based statin uptitration/ezetimibe combination regimen is useful to increase LDL cholesterol lowering where statin monotherapy has not achieved target lipid values.

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