Are add-on agents to statin therapy necessary in hypercholesterolemia?

Abstract Elevated cholesterol is a major risk factor for atherosclerosis and coronary heart disease, and its control remains poor. Diet and exercise may not achieve LDL-C goals, particularly in high-risk patients. Statins are first-line treatment for lowering LDL-C. Recent ACC/AHA guidelines focus on groups benefiting the most from a statin, as well as using higher dose statins rather than a low-dose statin in combination with other cholesterol-lowering agents. Statin monotherapy will be inadequate to get half of treated patients to LDL-C goal, necessitating add-on therapy. Combining a statin with a bile acid sequestrant, fibrate or ezetimibe can help achieve lipid goals, and a bile acid sequestrant has the unique ability to reduce LDL-C, while improving glycemic control in patients with diabetes.