additive effects of ezetimibe and statins in managing elevated ldl-c: an approach to reducing cardiovascular risk

Elevated low-density lipoprotein cholesterol (ldl-c) is a key modifiable risk factor for cardiovascular disease. while statins are the cornerstone of ldl-c-lowering therapy, their long-term use may result in dose-dependent adverse effects. ezetimibe, a niemann–pick c1-like 1 inhibitor, reduces intestinal cholesterol absorption and complements the reduction of hepatic cholesterol synthesis achieved through statin therapy. evidence from major trials, including improve-it, sharp, racing, and ewtopia 75, demonstrates that combination therapy achieves greater ldl-c reduction and provides modest improvements in clinical outcomes compared with statin monotherapy, while maintaining a favorable safety profile. the early initiation of combination therapy may permit the use of lower statin doses, thereby reducing adverse effects such as insulin resistance and hepatotoxicity. the co-administration of ezetimibe with statins, when implemented alongside guideline-recommended strategies, represents a rational and patient-centered approach for high-risk individuals. this strategy offers enhanced lipid control and improved safety outcomes relative to statin monotherapy.