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(Circulation. 2003;107:3124.)
© 2003 American Heart Association, Inc.

Clinician Update

Perspectives in Cholesterol-Lowering Therapy

The Role of Ezetimibe, a New Selective Inhibitor of Intestinal Cholesterol Absorption

Eric Bruckert, MD; Philippe Giral, MD; Philippe Tellier, MD

From the Service d’Endocrinologie-Métabolisme, AP-HP, Hôpital de la Pitié-Salpêtrière, Paris, France.

Correspondence to Prof Eric Bruckert, Department of Endocrinology, Hôpital de la Pitié-Salpêtrière, AP-HP, 83, Boulevard de l’Hôpital, 75651 Paris Cedex 13, France. E-mail eric.bruckert@psl.ap-hop-paris.fr

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Low-density lipoprotein cholesterol (LDL-C) reduction is a key factor in preventing coronary heart disease (CHD), particularly in high-risk patients. The greatest reductions in CHD mortality and morbidity have been achieved with the 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors, more commonly known as statins.¹ Optimal LDL-C levels have been set at 100 mg/dL and 115 mg/dL for high-risk patients by US and European guidelines, respectively.¹ To achieve these therapeutic target values for LDL-C, statins have become a mainstay in the treatment of hyperlipidemia.^1,2They are recommended as first-line pharmacological therapy in the majority of hyperlipidemic patients at increased risk of initial or recurrent manifestations of CHD.^1,2 Nevertheless, in clinical practice, despite major improvement in lipid management, current strategies may have important limitations with regard to the reduction of LDL-C, as illustrated by the following case presentations.

	Case Presentations

 
Case 1
A 51-year-old man showed evidence of an uncomplicated myocardial infarction. His body mass index was 25.5 kg/m². At baseline, his LDL-C level was 260 mg/dL. Dietary counseling had been strictly applied in combination with simvastatin (40 mg) during the 6 months after the coronary event. The patient had shown poor tolerance to bile acid sequestrants. Despite this strategy, fasting plasma concentrations of relevant metabolic variables (in mg/dL) were as follows: glucose 99, total cholesterol (TC) 220, LDL-C 160, high-density lipoprotein cholesterol (HDL-C) 40, and triglycerides (TG) 100.

To achieve therapeutic goals in such a clinical case, there are limited options. Doubling the daily dose of a statin up to 80 mg with either simvastatin or . . . [Full Text of this Article]

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