A recent study highlights that combination lipid-lowering therapy (LLT) leads to a more significant reduction in low-density lipoprotein cholesterol (LDL-C) compared to statin monotherapy. The study, published in the Mayo Clinic Proceedings on March 23, analyzed data from a variety of studies and found that combining therapies not only lowers LDL-C more effectively but also reduces the risk of major cardiovascular events.
The research, led by Dr. Maciej Banach from the Medical University of Lodz in Poland, involved a systematic review of 14 studies, which included 11 randomized controlled trials and three cohort studies, covering a total of 108,373 very high-risk patients. The primary focus was to compare the effectiveness of combination LLT with statin monotherapy in lowering LDL-C, while also considering the potential adverse events and outcomes associated with each treatment.
According to the findings, combination LLT achieved a greater reduction in LDL-C levels when compared to statin monotherapy. The pooled analysis showed a mean difference of -12.96 mg/dL in LDL-C reduction, indicating a more robust effect. In addition to this reduction, the combination therapy also led to a significant decrease in all-cause mortality and the incidence of major adverse cardiovascular events (MACE) and stroke, with odds ratios of 0.81, 0.82, and 0.83, respectively. However, the study did not observe any significant impact on cardiovascular mortality.
The researchers also evaluated the risk of adverse events and therapy discontinuation between the two treatment groups. Interestingly, there was no significant difference between the combination therapy and statin monotherapy in terms of adverse events or the likelihood of patients discontinuing their treatment. This suggests that the combination therapy’s benefits in reducing LDL-C and cardiovascular risk can be achieved without an increased risk of side effects or treatment noncompliance.
The results of this study strongly suggest that combination LLT should be considered as an initial treatment option for patients who are at very high risk for cardiovascular events. Dr. Banach and his colleagues emphasize that early intervention with combination therapy could maximize the chances of achieving LDL-C goals and improving long-term cardiovascular health. They also point out that these findings should be incorporated into clinical guidelines more prominently to ensure that patients benefit from the most effective treatment approach from the outset.
Several authors of the study disclosed financial ties to the biopharmaceutical industry, which is a common occurrence in research related to medical therapies. Nonetheless, the results of this study provide valuable insight into the role of combination lipid-lowering therapy in managing cholesterol levels and reducing cardiovascular risk, particularly for high-risk patients who could benefit from more aggressive treatment strategies.
