Management of mixed hyperlipidaemia

Abstract

This editorial refers to ‘Efficacy and safety of the coadministration of ezetimibe with fenofibrate in patients with mixed hyperlipidaemia’† by M. Farnier et al. , on page 897 The introduction of the HMG-CoA reductase inhibitors (statins) about 15 years ago has influenced the daily practice of cardiologists and other physicians enormously with respect to preventive strategies of first and second cardiovascular events. These drugs can lower the concentration of LDL-cholesterol by 30–60% and are generally well tolerated. In the last decade, randomized trials with statins have involved more than 90 000 patients, in which the overall safety and efficacy of the statins has been firmly established. The use of statins has, therefore, become the cornerstone of drug therapy in reducing the concentration of LDL-cholesterol and thereby the risk of cardiovascular disease and stroke, even in subjects without high serum cholesterol levels. Despite the success of statins in reducing cardiovascular morbidity and mortality, a substantial number of patients continue to have clinical events, which can partly be explained by the fact that other lipoprotein particles in addition to LDL contribute to the risk of cardiovascular disease, such as abnormalities in triglyceride-rich lipoproteins (very low-density lipoproteins, chylomicrons, or their remnants) and HDL.1 This is especially the case in … *Corresponding author. Tel: +31 243618819; fax: +31 243541734. E-mail address : a.stalenhoef{at}aig.umcn.nl