Reasons Why Combination Therapy Should Be the New Standard of Care to Achieve the LDL-Cholesterol Targets

PURPOSE OF REVIEW: The aim of this report is to review the scientific evidence supporting that lipid lowering therapy (LLT), beyond statins, reduces cardiovascular risk; therefore, treatment strategies based on lipid-lowering drug combination should be implemented. RECENT FINDINGS: A strong scientific body of evidence supports the effect of statins on cardiovascular risk reduction. Recent trials using non-statin LLT, ezetimibe, and PCSK9 inhibitors have provide scientific evidence about their impact on cardiovascular prevention. Current clinical guidelines still recommend using high-intensity statin monotherapy before considering combination therapy. The causal effect of LDL-C on atherosclerosis is well established. Moreover, new RCT, meta-analysis, and Mendelian randomization data, support that the main determinant of risk reduction is the absolute LDL reduction regardless of LLT. Accordingly, the "high-intensity statin therapy" concept should be substituted by "high-intensity lipid lowering therapy." Combination therapy must become the standard of care of hypercholesterolemia treatment.