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Conflicting cholesterol advice

I refer to the news story outlining expert advice to GPs on what to do for patients failing to meet national service framework cholesterol targets in spite of being on dose of 40mg of a statin. This suggested that the problem could be addressed by adding ezetimide.

Surprisingly the advice does not include increasing the statin to the top dose of 80mg, which applies to simvastatin and atorvastatin. This is against a background of 58 per cent of new patients started on the lowest dose of the prescribed statin and 89 per cent still on that dose at the end of 12 months. Surely it would be of greater benefit to the patient if they were started on a statin, which is known to achieve 46 per cent reduction in LDL-cholesterol on the lowest dose.

Ezetimide undoubtedly will have a role in cholesterol lowering strategies when combined with a generic statin. At present the place for ezetimide is in treating those with familial hypercholesterolaemia and in those who in spite of taking top doses of statin do not reach the target or are unable to tolerate even the lowest dose of a


Cholesterol management is only one of the many areas GPs are involved in on a daily basis and it is not helpful when experts give conflicting and contradictory advice.

There are significant implications in relation to costs when using add-on drugs ­ and more especially the effect an extra tablet will have on patient compliance.

Dr G D O'Neill


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