Leczenie skojarzone atorwastatyną z ezetymibem – miejsce we współczesnej lipidologii Artykuł przeglądowy
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Opublikowane:
lis 30, 2025
Słowa kluczowe:
dyslipidemia, atorwastatyna, ezetymib, terapia skojarzona
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Abstrakt
Hipercholesterolemia to najczęstszy modyfikowalny czynnik ryzyka chorób sercowo-naczyniowych w Polsce, jednakże jedynie niewielki odsetek chorych osiąga docelowe stężenie cholesterolu LDL. Atorwastatyna, należąca do grupy silnych statyn, ma wysoką skuteczność w redukcji stężenia cholesterolu LDL oraz częstości incydentów sercowo-naczyniowych, w tym zawału serca i udaru mózgu. Jej plejotropowe działanie obejmuje poprawę funkcji śródbłonka, właściwości przeciwzapalne i nefroprotekcyjne. Dodanie ezetymibu do leczenia statyną umożliwia uzyskanie dalszej, istotnej redukcji stężenia cholesterolu LDL, sięgającej 20–25%, bez zwiększenia ryzyka działań niepożądanych. Terapia skojarzona atorwastatyną i ezetymibem zmniejsza śmiertelność całkowitą sercowo-naczyniową oraz częstość poważnych incydentów sercowo-naczyniowych. Zastosowanie tej strategii terapeutycznej jest szczególnie uzasadnione u pacjentów z dużym lub bardzo dużym ryzykiem sercowo-naczyniowym, zwłaszcza w przebiegu cukrzycy, przewlekłej choroby nerek lub przy nietolerancji dużych dawek statyn.
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Jak cytować
Surma, S., Holecki, M., & Barylski, M. (2025). Leczenie skojarzone atorwastatyną z ezetymibem – miejsce we współczesnej lipidologii . Medycyna Faktów , 18(3(68), 360-366. https://doi.org/10.24292/01.MF.0325.04
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Bibliografia
1. Wełnicki M, Gorczyca-Głowacka I, Kapłon-Cieślicka A et al. Treatment of dyslipidemia in Poland – common diagnostics, early combined therapy. Expert position statement endorsed by the Polish Cardiac Society Working Group on Cardiovascular Pharmacotherapy. 5th Declaration of Sopot. Cardiol J. 2025; 32(2): 107-19. http://doi.org/10.5603/cj.103680.
2. Banach M, Surma S, Kapłon-Cieślicka A et al. Position paper of the Polish Expert Group on the use of pitavastatin in the treatment of lipid disorders in Poland endorsed by the Polish Lipid Association. Arch Med Sci. 2023; 20(1): 28-42. http://doi.org/10.5114/aoms/175879.
3. Surma S, Barylski M. Dyslipidemia – leczenie hipolipemizujące „od kuchni”. Terapia 2025; 6(449): 62, 64-70.
4. Patti G, Spinoni EG, Grisafi L et al. Safety and efficacy of very low LDL-cholesterol intensive lowering: a meta-analysis and meta-regression of randomized trials. Eur Heart J Cardiovasc Pharmacother. 2023; 9(2): 138-47. http://doi.org/10.1093/ehjcvp/pvac049.
5. Yebyo HG, Aschmann HE, Kaufmann M et al. Comparative effectiveness and safety of statins as a class and of specific statins for primary prevention of cardiovascular disease: A systematic review, meta-analysis, and network meta-analysis of randomized trials with 94,283 participants. Am Heart J. 2019; 210: 18-28. http://doi.org/10.1016/j.ahj.2018.12.007.
6. Ma W, Pan Q, Pan D et al. Efficacy and Safety of Lipid-Lowering Drugs of Different Intensity on Clinical Outcomes: A Systematic Review and Network Meta-Analysis. Front Pharmacol. 2021; 12: 713007. http://doi.org/10.3389/fphar.2021.713007.
7. Surma S, Barylski M. Leczenie hipolipemizujące – siła tkwi w… terapii skojarzonej statyna + ezetymib. Świat Medycyny i Farmacji. 2025; 4(283): 82, 84-90.
8. LaRosa JC, Grundy SM, Waters DD et al.; for the Treating to New Targets (TNT) Investigators. Intensive lipid lowering with atorvastatin in patients with stable coronary disease. N Eng J Med. 2005; 352: 1425-35.
9. Atorvastatin versus Revascularisation Treatment Investigators (AVERT). Aggressive lipid lowering therapy compared with angioplasty in stable coronary artery disease. N Engl J Med. 1999; 341: 70-84.
10. Koren MJ, Hunninghake DB; ALLIANCE Investigators. Clinical outcomes in managed-care patients with coronary heart disease treated aggressively in lipid-lowering disease management clinics: the alliance study. J Am Coll Cardiol. 2004; 44: 1772-9.
11. Olsson AG, Schwartz GG, Szarek M et al. High-density lipoprotein, but not low-density lipoprotein cholesterol levels influence short term prognosis after acute coronary syndrome: results from the MIRACL trial. Eur Heart J. 2005; 26: 890-6.
12. Ray KK, Cannon CP, McCabe CH et al. Early and late benefits of high-dose atorvastatin in patients with acute coronary syndromes: results from the PROVE IT-TIMI 22 trial. J Am Coll Cardiol. 2005; 46: 1405-10.
13. Colhoun HM, Betteridge DJ, Durrington PN et al. Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomised placebo-controlled trial. Lancet. 2004; 364: 685-96.
14. Sever PS, Dahlof B, Poulter NR et al. Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial – Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial. Lancet. 2003; 361: 1149-58.
15. Amarenco P, Bogousslavsky J, Callahan A 3rd et al.; for the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Investigators: High-dose atorvastatin after stroke or transient ischemic attack. N Engl J Med. 2006; 355: 549-59.
16. de Zeeuw D. Different renal protective effects of atorvastatin and rosuvastatin in diabetic and non-diabetic renal patients with proteinuria. Results of the PLANET trials: 2010 European Renal Association – European Dialysis and Transplant Association Congress; June 27, 2010; Munich, Germany.
17. Vogt L, Bangalore S, Fayyad R et al. Atorvastatin Has a Dose-Dependent Beneficial Effect on Kidney Function and Associated Cardiovascular Outcomes: Post Hoc Analysis of 6 Double-Blind Randomized Controlled Trials. J Am Heart Assoc. 2019; 8(9): e010827. http://doi.org/10.1161/JAHA.118.010827.
18. Surma S, Ciechanowski K. Przewlekła choroba nerek związana z otyłością – epidemiologia, patofizjologia i leczenie. Terapia. 2025; 4(448): 53-63.
19. Banach M, Jaiswal V, Ang SP et al.; Lipid and Blood Pressure Meta-analysis Collaboration (LBPMC) Group and the International Lipid Expert Panel (ILEP). Impact of Lipid-Lowering Combination Therapy With Statins and Ezetimibe vs Statin Monotherapy on the Reduction of Cardiovascular Outcomes: A Meta-analysis. Mayo Clin Proc. 2025: S0025-6196(25)00075-8. http://doi.org/10.1016/j.mayocp.2025.01.018.
20. Mach F, Koskinas KC, Roeters van Lennep JE et al.; ESC/EAS Scientific Document Group. 2025 Focused Update of the 2019 ESC/EAS Guidelines for the management of dyslipidaemias. Eur Heart J. 2025; 46(42): 4359-78. http://doi.org/10.1093/eurheartj/ehaf190.
21. Lin YC, Lai TS, Wu HY et al. Effects and Safety of Statin and Ezetimibe Combination Therapy in Patients with Chronic Kidney Disease: A Systematic Review and Meta-Analysis. Clin Pharmacol Ther. 2020; 108(4): 833-43. http://doi.org/10.1002/cpt.1859.
2. Banach M, Surma S, Kapłon-Cieślicka A et al. Position paper of the Polish Expert Group on the use of pitavastatin in the treatment of lipid disorders in Poland endorsed by the Polish Lipid Association. Arch Med Sci. 2023; 20(1): 28-42. http://doi.org/10.5114/aoms/175879.
3. Surma S, Barylski M. Dyslipidemia – leczenie hipolipemizujące „od kuchni”. Terapia 2025; 6(449): 62, 64-70.
4. Patti G, Spinoni EG, Grisafi L et al. Safety and efficacy of very low LDL-cholesterol intensive lowering: a meta-analysis and meta-regression of randomized trials. Eur Heart J Cardiovasc Pharmacother. 2023; 9(2): 138-47. http://doi.org/10.1093/ehjcvp/pvac049.
5. Yebyo HG, Aschmann HE, Kaufmann M et al. Comparative effectiveness and safety of statins as a class and of specific statins for primary prevention of cardiovascular disease: A systematic review, meta-analysis, and network meta-analysis of randomized trials with 94,283 participants. Am Heart J. 2019; 210: 18-28. http://doi.org/10.1016/j.ahj.2018.12.007.
6. Ma W, Pan Q, Pan D et al. Efficacy and Safety of Lipid-Lowering Drugs of Different Intensity on Clinical Outcomes: A Systematic Review and Network Meta-Analysis. Front Pharmacol. 2021; 12: 713007. http://doi.org/10.3389/fphar.2021.713007.
7. Surma S, Barylski M. Leczenie hipolipemizujące – siła tkwi w… terapii skojarzonej statyna + ezetymib. Świat Medycyny i Farmacji. 2025; 4(283): 82, 84-90.
8. LaRosa JC, Grundy SM, Waters DD et al.; for the Treating to New Targets (TNT) Investigators. Intensive lipid lowering with atorvastatin in patients with stable coronary disease. N Eng J Med. 2005; 352: 1425-35.
9. Atorvastatin versus Revascularisation Treatment Investigators (AVERT). Aggressive lipid lowering therapy compared with angioplasty in stable coronary artery disease. N Engl J Med. 1999; 341: 70-84.
10. Koren MJ, Hunninghake DB; ALLIANCE Investigators. Clinical outcomes in managed-care patients with coronary heart disease treated aggressively in lipid-lowering disease management clinics: the alliance study. J Am Coll Cardiol. 2004; 44: 1772-9.
11. Olsson AG, Schwartz GG, Szarek M et al. High-density lipoprotein, but not low-density lipoprotein cholesterol levels influence short term prognosis after acute coronary syndrome: results from the MIRACL trial. Eur Heart J. 2005; 26: 890-6.
12. Ray KK, Cannon CP, McCabe CH et al. Early and late benefits of high-dose atorvastatin in patients with acute coronary syndromes: results from the PROVE IT-TIMI 22 trial. J Am Coll Cardiol. 2005; 46: 1405-10.
13. Colhoun HM, Betteridge DJ, Durrington PN et al. Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomised placebo-controlled trial. Lancet. 2004; 364: 685-96.
14. Sever PS, Dahlof B, Poulter NR et al. Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial – Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial. Lancet. 2003; 361: 1149-58.
15. Amarenco P, Bogousslavsky J, Callahan A 3rd et al.; for the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Investigators: High-dose atorvastatin after stroke or transient ischemic attack. N Engl J Med. 2006; 355: 549-59.
16. de Zeeuw D. Different renal protective effects of atorvastatin and rosuvastatin in diabetic and non-diabetic renal patients with proteinuria. Results of the PLANET trials: 2010 European Renal Association – European Dialysis and Transplant Association Congress; June 27, 2010; Munich, Germany.
17. Vogt L, Bangalore S, Fayyad R et al. Atorvastatin Has a Dose-Dependent Beneficial Effect on Kidney Function and Associated Cardiovascular Outcomes: Post Hoc Analysis of 6 Double-Blind Randomized Controlled Trials. J Am Heart Assoc. 2019; 8(9): e010827. http://doi.org/10.1161/JAHA.118.010827.
18. Surma S, Ciechanowski K. Przewlekła choroba nerek związana z otyłością – epidemiologia, patofizjologia i leczenie. Terapia. 2025; 4(448): 53-63.
19. Banach M, Jaiswal V, Ang SP et al.; Lipid and Blood Pressure Meta-analysis Collaboration (LBPMC) Group and the International Lipid Expert Panel (ILEP). Impact of Lipid-Lowering Combination Therapy With Statins and Ezetimibe vs Statin Monotherapy on the Reduction of Cardiovascular Outcomes: A Meta-analysis. Mayo Clin Proc. 2025: S0025-6196(25)00075-8. http://doi.org/10.1016/j.mayocp.2025.01.018.
20. Mach F, Koskinas KC, Roeters van Lennep JE et al.; ESC/EAS Scientific Document Group. 2025 Focused Update of the 2019 ESC/EAS Guidelines for the management of dyslipidaemias. Eur Heart J. 2025; 46(42): 4359-78. http://doi.org/10.1093/eurheartj/ehaf190.
21. Lin YC, Lai TS, Wu HY et al. Effects and Safety of Statin and Ezetimibe Combination Therapy in Patients with Chronic Kidney Disease: A Systematic Review and Meta-Analysis. Clin Pharmacol Ther. 2020; 108(4): 833-43. http://doi.org/10.1002/cpt.1859.