What is the recommended approach for very high-risk patients?
The guideline strongly recommends (COR 1) that ezetimibe be added to maximally tolerated statin as a first step to further lower LDL-C. This approach is supported by two simulation studies from large populations of very high-risk patients showing that ezetimibe plus statin therapy lowers LDL-C to <70 mg/dL (1.8 mmol/L) in most patients, leaving a minority eligible for a PCSK9 inhibitor.