Synopsis: The increased CVD risk of hyperlipidemic (HL) patients is only partly quantified by the standard lipid panel (TG, cholesterol, LDL and HDL). As differences in lipoprotein composition can influence atherogenicity, assessment of the lipoprotein subclass profile may aid in risk assessment and in guiding therapy.

Objective: Evaluate the lipid-altering effects of ezetimibe added to ongoing statin therapy, statin titration, switching from statin monotherapy to a more potent statin or to ezetimibe/simvastatin. Methods: A pooled analysis of patient-level data from 17 double-blind, active or placebo-controlled studies of 8667 hypercholesterolemic adults randomized to ezetimibe 10 mg added to ongoing statins, statin titration (doubling), or switching from ongoing statins to rosuvastatin (10 mg) or to ezetimibe/simvastatin (10/20 and 40 mg). Percent change from baseline in low-density lipoprotein cholesterol (LDL-C) was estimated by analysis of variance. Percent of patients who achieved LDL-C and other guideline-recommended targets, and target lipid levels by baseline distance to goal were evaluated. Results: LDL-C percent change from baseline was −26.0 for ezetimibe added to ongoing statin therapy, −27.6 for switching from ongoing statin to ezetimibe/simvastatin, −19.7 for switching to rosuvastatin 10 mg, and −9.7 for dose doubling of the ongoing statin. For patients within 0.8 mmol/L (30 mg/dL) of the target at baseline, LDL-C target attainment rates were 75.9% for adding ezetimibe to ongoing statin, 72.8% for switching to ezetimibe/simvastatin, 61.8% for switching to rosuvastatin, and 44.3% for statin dose-doubling. Similarly, improvements in other lipids and achievement of non-high-density lipoprotein cholesterol and apolipoprotein B targets among this patient group were largest for ezetimibe added to ongoing statins and switching to ezetimibe/simvastatin; switching to rosuvastatin 10 mg and statin dose-doubling were less effective. Conclusions: Adding ezetimibe to ongoing statin therapy appeared to be an effective option for patients who do not achieve lipid-lowering goals on statins alone.