Bridging Guidelines and Practice: Expert Insights on Early Rosuvastatin–Ezetimibe Combination Therapy

Background: Cardiovascular disease remains the leading cause of mortality globally and in India, driven by a high burden of dyslipidemia and premature coronary artery disease. Despite widespread statin use, attainment of recommended LDL-C targets in real-world practice remains suboptimal. Contemporary ESC/EAS, CSI, and LAI guidelines advocate aggressive LDL-C goals (<55 mg/dL) and early combination therapy, underscoring the need for expert-informed real-world insights.

Materials and Methods: This expert-opinion analysis incorporated structured polling conducted across five advisory board forums involving approximately 50 practicing cardiologists from India. Fourteen predefined electronic polling questions assessed LDL-C targets, treatment preferences in primary and secondary prevention, observed lipid-lowering responses, and treatment duration.

Results: In primary prevention, most respondents supported rosuvastatin 40 mg plus ezetimibe for very-high or extreme-risk patients, while statin monotherapy remained the most common initial approach overall. In hospitalized ASCVD patients, rosuvastatin–ezetimibe was the preferred regimen (44%), typically initiated at LDL-C <55 mg/dL (63%). Similar trends were observed post-PCI, where combination therapy predominated and <55 mg/dL was the principal threshold (68%). The regimen was widely prescribed, achieving typical LDL-C reductions of 40–50%, and was commonly continued beyond 12 months, including extended or lifelong use in selected high-risk patients.

Conclusion: Expert polling indicates substantial alignment between real-world cardiology practice and guideline-recommended aggressive lipid management. Rosuvastatin–ezetimibe therapy is widely adopted across ASCVD and post-PCI settings, with reported effectiveness consistent with clinical trial data, supporting an evolving shift toward early and sustained combination lipid-lowering strategies.