Changes/additions to materials:

Ezetimibe and cancer — reassuring data
As we have blogged, an analysis of post-marketing adverse event reports did not find any increased risk of cancer with ezetimibe▼ compared with statins, either alone or when taken in combination with simvastatin. Although these data are reassuring, it would seem sensible to use ezetimibe▼ only with caution because there is no published evidence of its benefit on clinically important outcomes such as cardiovascular events and its long-term safety is unknown. Prescribers should continue to use evidence-based statins (e.g. simvastatin 40mg/day) first-line in most patients who require a lipid-lowering agent.

A MeReC Bulletin on lipid-modifying treatment is now available. It:

• addresses the similarities and differences between NICE guidance for people with and without type 2 diabetes
• provides clarification on NICE’s recommendations regarding thresholds for intensifying treatment
• discusses the evidence base for high-intensity statins, for rosuvastatin and for ezetimibe▼, the reliability of single cholesterol measurements, and the side effects of statins.

Work through these two case studies to explore your understanding of lipid therapy. The answers provided are examples of good practice, and not the only correct answer.

Case study 1 - Paul - lipid therapy in someone at increased risk of CVD who hasn't had a CV event ('primary prevention')

Case study 2 - John - lipid therapy in someone with CVD ('secondary prevention')