Send to

Choose Destination
Am J Cardiol. 2018 Oct 19. pii: S0002-9149(18)31970-2. doi: 10.1016/j.amjcard.2018.09.041. [Epub ahead of print]

Usefulness of Low-Dose Statin Plus Ezetimibe and/or Nutraceuticals in Patients With Coronary Artery Disease Intolerant to High-Dose Statin Treatment.

Author information

Instituto di Ricerca a Carattere Scientifico (IRCCS) San Raffaele, Rome, Italy. Electronic address:
Instituto di Ricerca a Carattere Scientifico (IRCCS) San Raffaele, Rome, Italy.
University of Rome "la Sapienza", Rome, Italy.
University of Campania, Caserta, Italy.
Institute of Cardiology, Madre Giuseppina Vannini Hospital, Rome, Italy.
Instituto di Ricerca a Carattere Scientifico (IRCCS) San Raffaele, Rome, Italy; St George's Hospital NHS Trust Medical School, London, United Kingdom.


High-dose statin (HDS) therapy is recommended to reduce low-density lipoprotein cholesterol (LDL-C); however, some patients are unable to tolerate the associated side effects. Nutraceuticals have shown efficacy in lowering LDL-C. The aim of this study was to evaluate whether the combination of low-dose statin (LDS) plus ezetimibe (EZE) or LDS plus nutraceutical (Armolipid Plus [ALP] containing red yeast rice, policosanol, and berberine) can lead to a higher proportion of high-risk patients achieving target LDL-C. A secondary objective was to assess the efficacy of triple combination LDS + EZE + ALP in resistant patients (LDL-C >70 mg/dl). A randomized, prospective, parallel-group, single-blind study was conducted in patients with coronary artery disease (n = 100) who had undergone percutaneous coronary intervention in the preceding 12 months, were HDS-intolerant, and were not at LDL-C target (<70 mg/dl) with LDS alone. Patients received either LDS + EZE or LDS + ALP. Of the 100 patients, 33 patients (66%) treated with LDS + EZE and 31 patients (62%) treated with LDS + ALP achieved target LDL-C after 3 months, which was maintained at 6 months. Patients who did not achieve the therapeutic goal received a triple combination of LDS + EZE + ALP for a further 3 months. At 6 months, 28 of 36 patients (78%) achieved LDL-C target. Overall, 92% of patients enrolled in this study were at target LDL-C at 6 months. No patients in any group experienced major side effects. In conclusion, in HDS-intolerant coronary artery disease patients, the combination of LDS plus EZE and/or ALP represents a valuable therapeutic option allowing most patients to reach target LDL-C within 3 to 6 months.

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center