A systematic review concluded that lower-intensity statin combined with bile acid sequestrant or ezetimibe may be effective to reduce LDL cholesterol among high-risk hyperlipidemic patients. A total of 36 trials were included in the review. Low-intensity statin plus bile acid sequestrant decreased LDL cholesterol level 0% to 14% more than mid-intensity monotherapy among high-risk hyperlipidemic patients. Mid-intensity statin plus ezetimibe decreased LDL cholesterol level 5% to 15% and 3% to 21% more than high-intensity monotherapy among patients with atherosclerotic cardiovascular disease and diabetes mellitus, respectively. Evidence was insufficient to evaluate LDL cholesterol for fibrates, niacin, and ω-3 fatty acids. Evidence was insufficient for long-term clinical outcomes, adherence, and harms for all regimens. Some patients do not tolerate or respond to high-intensity statin monotherapy although the strategy offers evidence-based risk reduction for many patients. Source: http://annals.org/一项系统综述的结论是较低强度的他汀类药物与胆汁酸螯合剂或依泽替米贝可有效降低高危高脂血症患者的低密度脂蛋白胆固醇。该综述共纳入36个临床试验。对高风险性高脂血症患者，低强度的他汀类药物加胆汁酸螯合剂降低的低密度脂蛋白胆固醇水平超过中强度他汀类单一疗法的0％至14％。对冠心病和糖尿病患者，中等强度他汀类药物加依泽替米贝降低的低密度脂蛋白胆固醇水平分别超过高强度他汀类单药治疗的5％到15％和3％至21％。已有证据不足以评定贝特类，烟酸和ω-3脂肪酸对低密度脂蛋白胆固醇的疗效。已有证据也不足以评定上述所有治疗方案的长期疗效，坚持用药状况以及危害。部分患者对高强度的他汀类药物单药治疗不能耐受或无效，尽管有证据该疗法降低了许多病人的风险。来源：http://annals.org/
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