The rationale for combination therapy

The use of combination lipid-altering therapy for dyslipidemia is becoming increasingly important for effective management of patients with coronary heart disease (CHD). In accordance with the Adult Treatment Panel III guidelines, the primary target of therapy is lowering low-density lipoprotein (LDL) cholesterol. Studies have demonstrated the benefit of LDL cholesterol reduction in decreasing CHD event rates and all-cause mortality. However, low high-density lipoprotein (HDL) cholesterol remains a significant predictor of CHD events. In addition, lipid-lowering therapy targeting aberrant lipopro-tein subclass and triglyceride levels afford additional benefit for patients with mixed dyslipidemias. Aggressive lipid-altering therapy often requires the use of combination therapy involving statins in conjunction with niacin, fibric-acid derivatives, or bile acid resins or intestinal inhibitors of active cholesterol transport. This article reviews the rationale for the use of combination therapy in the treatment of dyslipidemia, highlighting management strategies.