agency for healthcare research and quality (AHRQ) just came out with their treatise on the utility of combination therapy vs just intensigfying statin therapy alone. see
this 394-page, exhaustive analysis basically found that there are NO good clinical data supporting combination therapy. Yes, there are some good surrogate outcomes: statin plus ezetimibe or bile acid sequestrant does lower LDL more than just intensifying the statin monotherapy. BUT, we are treating patients not lipids. so, i think that one of the most important and useful conclusions of the AHA lipid management guidelines is that they strongly come out against combination therapy. and this analysis by AHRQ provides detailed support. it is basically a tribute to big pharma marketing that ezetimibe has become one of the most profitable drugs on the market (from PharmaTimes: “Sales of the cholesterol drugs Vytorin (ezetimibe plus simvastatin) and Zetia (ezetimibe) reached $444 million and $614 million” in 2012), based on no clinical efficacy documented….
geoff