Effect and safety of combination lipid‐lowering therapies based on statin treatment versus statin monotherapies on patients with high risk of cardiovascular events

This study aimed to compare the effect and safety of statin monotherapies and combination therapies on lipid‐lowing therapies. We searched for published randomized controlled trial (RCT) reports of statin monotherapies and combination therapies in patients with high risk of cardiovascular events, and extracted lipid levels to perform meta‐analysis. A total of 12 RCT reports were included in this study. According to the new guidelines (low‐density lipoprotein cholesterol [LDL‐C] < 100 mg/dL, high‐density lipoprotein cholesterol [HDL‐C] > 130 mg/dL), the percent of LDL‐C attaining goals in combination therapy is more than that of monotherapy (risk ratio [RR] = 1.43, 95% confidence interval [CI]: 1.13 to 1.82, P = 0.003), and the percent of LDL‐C and HDL‐C attaining goals in combination therapy is greater than that of monotherapy (RR = 1.43, 95% CI: 1.24 to 1.65, P = 0.000). The changing level of blood lipid had significant statistical difference between the two groups. The degree of blood lipid lowered by combination therapy was larger than in monotherapy (standard mean difference [SMD] = −0.45, 95% CI: −0.75 to −0.14, P = 0.004; SMD = −0.72, 95% CI: 0.04 to 1.39, P = 0.039; and SMD = −0.71, 95% CI: −1.12 to −0.3, P = 0.001 in LDL‐C, HDL‐C, and triglyceride, respectively). The incidence of adverse events was not significantly different between the two groups (RR = 1.15, 95% CI: 0.91 to 1.37, P = 0.096; RR = 1.5, 95% CI: 0.55 to 4.1, P = 0.427; RR = 0.63, 95% CI: 0.33 to 1.24, P = 0.181 in incidence of total adverse events, drug‐related treatment, and myalgia, respectively). Combination therapy can bring better effect in reducing lipid. It does not increase the incidence of adverse events, so it can be used widely and safely.