Clinical Efficacy of Combined Lipid-Lowering Therapy in Ischemic Heart Disease: Outcomes of Statin and Ezetimibe Therapy

Ischemic heart disease (IHD) is one of the most important manifestations of atherosclerotic cardiovascular disease and remains a major cause of recurrent myocardial infarction, coronary revascularization, heart failure, and cardiovascular mortality. Low-density lipoprotein cholesterol (LDL-C) is a causal factor in the development and progression of atherosclerosis, making intensive LDL-C reduction a cornerstone of secondary cardiovascular prevention. Although statins remain the first-line pharmacological treatment, a substantial proportion of patients do not achieve recommended LDL-C targets with maximally tolerated statin therapy alone. The addition of ezetimibe provides a complementary mechanism of LDL-C reduction by inhibiting intestinal cholesterol absorption. This literature review evaluates the clinical efficacy of combined statin and ezetimibe therapy in patients with IHD. Evidence from randomized controlled trials, comparative studies, and contemporary clinical guidelines was analyzed. The IMPROVE-IT trial demonstrated that adding ezetimibe to statin therapy after acute coronary syndrome produced additional LDL-C reduction and a significant decrease in major cardiovascular events [1]. The RACING trial subsequently showed that moderate-intensity rosuvastatin combined with ezetimibe was non-inferior to high-intensity rosuvastatin monotherapy for a composite cardiovascular outcome, while achieving higher rates of LDL-C target attainment [2]. Current evidence therefore supports combination therapy as an effective strategy for patients who do not achieve LDL-C targets with statin monotherapy or who require intensive lipid lowering while minimizing statin-related intolerance.