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Statin add-on is better than switch to new statin

By Nigel Praities

Patients not achieving their goals on simvastatin alone should be co-prescribed ezetimibe rather than being switched to a more potent statin, a UK study concludes.

The study – based in 34 general practices – followed 1,800 patients with established cardiovascular disease, diabetes or at high risk of CVD.

Nearly half (45%) did not achieve Joint British Societies and NICE ‘audit standard' LDL-cholesterol goals of less than 2.0 mmol/L after six weeks or more of taking 40mg simvastatin.

Patients were then randomised to either receive 10mg of ezetimibe as an add-on therapy, atorvastatin 40mg or rosuvastatin 5 mg.

Those on the simvastatin/ezetimibe combination were better controlled than those switched to another statin, with 69% achieving the cholesterol target. This compared with 34% on atorvastatin and 14% on rosuvastatin.

Lead author Dr Terry McCormack, a GP in Whitby, North Yorkshire, said the study had a ‘clear outcome' that was directly applicable to UK primary care.

‘GPs should look at the numbers and judge for themselves which strategy they would wish to adopt,' he said.

The study was supported by the manufacturers of ezetimibe, Merck Sharp and Dohme Ltd and Schering Plough Ltd.

Int J Clin Prac 2010, online May 12

Dr Terry McCormack