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Systematic review
Very-low-strength evidence suggests that combining ezetimibe or fibrate with statins is no more effective than high-dose statin monotherapy for reducing all-cause mortality
  1. Alexander Tenenbaum,
  2. Enrique Z Fisman
  1. Sackler Faculty of Medicine, Tel-Aviv University, Israel
  1. Correspondence to Professor Alexander Tenenbaum
    Cardiac Rehabilitation Institute, Chaim Sheba Medical Center, Tel-Hashomer 52621, Israel; altenen{at}post.tau.ac.il

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Sharma and colleagues' systematic review aims to compare the benefits and harms of high-dose statin monotherapy with those of combination therapy. Most of the studies reviewed were short and focused on surrogate markers, which limited their ability to detect potential differences in important clinical outcomes. In fact, current data are insufficient to reach any definitive conclusions. However, contrary to the presented evidence (or, more accurately, absence of evidence), Sharma and colleagues conclude in their abstract that “Limited evidence suggests that combinations of lipid-lowering agents do not improve clinical outcomes more than high-dose statin monotherapy.” In fact, the opposite is true: data from studies using surrogate end points suggest that statin-based combination therapy appears to be more helpful in …

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