Fixed dose combination of Rosuvastatin plus ezetimibe for lipid management in clinical practice – The road less travelled!

INTRODUCTION Atherosclerotic cardiovascular (ASCVD) diseases are the leading causes of death worldwide. Meta-analyses of statin trials have convincingly shown that low-density lipoprotein cholesterol (LDL-C) lowering unequivocally reduces cardiovascular (CV) events (21% per mmol of LDL-C reduction) irrespective of age, sex, and presence of prior vascular disease.1,2 More intensive statin therapy leads to further 0.5 mmol LDL-C reduction and 15% additional CV event reduction vis-à-vis less intensive regimens.3 Consequently, both national and international guidelines recommend statin therapy as the first-line lipid-lowering agent.4–6 However, real-world studies have shown poor uptake of LDL-C lowering in clinical practice and consequent failure to achieve LDL-C goals as prescribed by guidelines in the management of patients with ASCVD Figure 1. The DA VINCI study was a large observational cross-sectional study across 18 European countries and revealed that only 56% achieved their LDL-C goal (1400 patients with uncontrolled dyslipidemia despite statin therapy. Their primary endpoint was LDL-C reduction. The criteria for uncontrolled dyslipidemia used a high/very high-risk category patient in the study (>70 mg/dl) are quite liberal, going beyond the ESC/EAS (35,000 patients with a diagnosis of myocardial infarction led to a significant reduction of MACE compared to no ezetimibe or late initiation of ezetimibe. The LAI and Cardiological Society of India guidelines already recommend upfront high-intensity Statin plus ezetimibe combination in all ACS patients.4,17 The availability of an FDC of rosuvastatin and ezetimibe in all strengths (10/10, 20/10, and 40/10) in our country has boosted the physician’s armamentarium. While the 10 mg/10 mg and 20 mg/10 mg FDCs are ideally suited for stable ASCVD subjects, the 40/10 FDC is ideal in ACS patients for early attainment of stringent LDL-C targets laid down by the guidelines. Ethical approval Not needed as it is an invited editorial. Authors’ contributions Akshyaya Pradhan and Abhishek Singh conceived the manuscript. Akshyaya Pradhan did the literature search. Abhishek Singh and Alok Kumar Singh prepared the draft and AP critically reviewed it.