Mitigating Cardiovascular Risk Through Effective Lipid Management - Episode 8

Using Adjunct Therapies in LDL Management

Dr Brinton highlights the importance of adjunct therapies in LDL management.

Eliot Brinton, MD: Only a tiny, tiny fraction of patients who need LDL [low-density lipoprotein] lowering ever have prescribed or even have a serious discussion with their doctor about anything beyond a statin. We need to get past the days when we didn’t have statin adjuncts that were worth much, and we need to get past the days when the only statin adjuncts were super expensive and not very effective. We now have a combination of some very inexpensive, generic statin adjuncts that we’re not using, hardly at all, and some extraordinarily effective statin adjuncts that are more effective than the statins. These are recent developments and ones that a lot of us just haven’t caught up with. We’re stuck in the early 1990s when it was a battle among the statins, what dose of which statin? That’s an important question, but we must be prepared quickly. I would say in at least half, and I would maybe even say two-thirds of our patients, we should be actively considering statin adjuncts. Now it’s another pill. It’s another shot. It’s whatever it is but the only thing worse than taking an extra drug is not taking an extra drug when in fact that would be the best thing for you to do. Statin monotherapy it’s fabulous and for many patients, it’s totally adequate, but for a large share and it’s roughly a half of our patients, statin monotherapy is not ideal because either we’re banging up against a bad statin intolerance issue, an adverse effect that is bothering the patient although they’re going to try to keep taking it anyway, or we simply don’t have adequate efficacy or sometimes it’s both. My plea to everyone is to be quick on the trigger with statin adjuncts. Don’t do it unless you need it. Statin monotherapy is always first line but realize that about half the cases it’s inappropriate to stay just with a statin and say, “Oh, no, we’re not going to use an adjunct because they’re too new or they’re too expensive or whatever.” That’s not an appropriate stance these days.


This transcript has been edited for clarity.