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Atherosclerosis is the primary cause of mortality in our field. Secondary prevention trials show that lowering c-LDL is associated with reduced coronary risk. Hence, sometimes, despite the high dosages of statins, the objective which has been recommended by various panels of experts, only achieves results in a modest 10-20% of patients, as is usual in patients with cardiovascular disease (CVD), with elevated risk of sustaining it, or in diabetic patients, for whom most associations suggest an c-LDL <70 mg/dl.
Ezitimibe is the first selective inhibitor of dietary cholesterol and billiary absorption in the intestinal wall, through the absorption of the NPCL1 transporter protein. Monotherapy has achieved an average reduction of 20% in total cholesterol readings (TC), 22% in c-LDL and 10% in TG, with a minimal increase (3%) of c-HDL. Ezetimibe, in monotherapy and in combined therapy, has shown that as well as reducing levels of inflammatory markers, reactive C-protein and ferritin, have improved endothelial functions.
Patients are increasingly in need of lipid-lowering drug treatments, and more intensive ones, in order to achieve their c-LDL objectives. Since the normal statin dosages reduce the concentrations of c-LDL by 30-40%, in some cases monotherapy using statin is insufficient in order to achieve optimum effects, preferably in high-risk patients. Double therapy, statin-ezetimibe, reduces c-LDL levels with greater efficacy than a single statin and is a more effective strategy for achieving objectives.
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