by Colin Kenny, GP, Dromore
In spite of a number of short-term outcomes studies on the use of statins and other lipid-lowering drugs, alone or in combination, primary care teams are still not clear if they should intensify statin therapy or use combination therapy. NICE guidance that is currently at the consultation stage may clarify matters later in 2014, but until then practitioners should consider evidence from a panel of American investigators who analysed all relevant trials and concluded that evidence is still lacking for combination therapy – relative to intensification of statins – improving long-term outcomes.
The US Agency for Healthcare Research and Quality supported a new systematic review of lipid-lowering treatment, which has recently been published. The body formed a panel of experts and paired them to focus attention on the strengths and limitations of evidence from studies investigating the effectiveness and safety of clinical interventions in lipid management.
Fifty-five studies, reported in 59 articles, were included in the analysis. All studies were randomised controlled trials. The researchers found that although many studies looked at intermediate outcomes, few studies addressed the question of which approach produces better clinical outcomes. Combination of a statin with ezetimibe or a bile acid sequestrant was associated with a greater lowering of LDL-cholesterol than was intensification of statin monotherapy, but evidence for important cardiovascular clinical outcomes was insufficient for all combination therapy regimens. Inevitably, the researchers called for additional studies to evaluate long-term clinical benefits and harms.
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