Hyperlipidemia, especially elevated low-density lipoprotein cholesterol (LDL-C), is one of the important risk factors for death from coronary heart disease. However, the awareness, treatment and control rates of dyslipidemia in my country are low. The traditional "step-by-step" lipid-lowering strategy starts with statin alone and gradually adds the drug. At a time when target values are becoming increasingly strict, this model is likely to increase the difficulty of reaching the target and the risk of adverse reactions, and reduce patient compliance.
In 2026, the Cardiometabolic Medicine Professional Committee of the National Cardiovascular Disease Expert Committee formulated the "Chinese Expert Consensus on Selection of Initial Cholesterol Lowering Strategies" based on sufficient evidence. The "Consensus" emphasizes goal orientation, risk stratification, and initial alliance. For people at very high or ultra-high risk of atherosclerotic cardiovascular disease (ASCVD), especially Chinese patients, compared with high-intensity statin monotherapy, using moderate-intensity statin combined with ezetimibe as an initial cholesterol-lowering strategy can further improve patient compliance and LDL-C compliance rate, thereby bringing about more significant cardiovascular benefits.
"Silent killer" hides hidden dangers, and blood lipid management is the difficulty in primary prevention
"As a core risk factor for cardiovascular and cerebrovascular diseases, dyslipidemia is the most difficult to manage in the management of the three highs." Professor Qian Juying, chief physician of the Department of Cardiology, Zhongshan Hospital Affiliated to Fudan University, said that under normal circumstances, if patients do not take the initiative to check, it is difficult to know whether their blood lipids are up to standard, which is unfavorable from the perspective of ASCVD prevention and treatment.
To change the current situation of blood lipid management, Professor Qian Juying suggested starting with screening, increasing the intensity of screening for hyperlipidemia, and allowing patients to know their blood lipid status early; from the perspective of ASCVD prevention and treatment, combined with ASCVD plaque screening and risk stratification, to develop appropriate blood lipid management goals for each person; coupled with the improvement in the accessibility of combined treatments, the rate of blood lipid management compliance is expected to increase, thereby reducing the overall risk of ASCVD events.
(Professor Qian Juying, chief physician of the Department of Cardiology, Zhongshan Hospital Affiliated to Fudan University)
From this point of view, it is also very important to choose the type of combination medication. "There is still a lot of emphasis on which drugs to use in statin combination therapy. The goal is to achieve "1+1>2", so cholesterol absorption inhibitors are the first choice." Professor Qian Juying, a participant in the formulation of the "Consensus" explained that statins inhibit cholesterol synthesis in the liver and reduce the concentration of cholesterol in liver cells. As the cholesterol concentration increases, the expression of LDL receptors on the surface of liver cells increases, and cholesterol clearance increases; however, after the cholesterol concentration in liver cells decreases, the intestinal absorption of cholesterol will increase compensatoryly. At this time, the addition of cholesterol absorption inhibitors can exactly reduce this compensation and achieve "1+1>2".
Statin + ezetimibe, the "double base drug" combination has been launched at the grassroots level
In 2026, ezetimibe was officially included in the National Essential Medicines List, becoming the only cholesterol absorption inhibitor selected among the 109 new drugs. So far, ezetimibe and statins, which are also in the "National Essential Drugs List", together form a "double base drug combination" in the field of lipid lowering.
"In the combined treatment of blood lipids, cholesterol absorption inhibitors are particularly commonly used drugs. As a representative drug of cholesterol absorption inhibitors, ezetimibe has been in China for 20 years. In recent years, as the evidence-based evidence has become more and more abundant, the application of ezetimibe has become more and more widespread." Professor Qian Juying said, "This year, ezetimibe has been included in the basic medicines , conveys two messages: on the one hand, it is a signal that the national health policy and the medical community affirm the combination therapy; on the other hand, the administrative health policy making department recognizes that blood lipid management and the reduction of ASCVD events can play an important role in promoting cardiovascular health, and provides support for the accessibility of drugs that patients with such chronic diseases need to use for a long time. "
In the future, with the support of national policies, the drugs in the essential drug catalog will be equipped in community health centers and other primary medical institutions. Patients can get the drugs they need at their doorsteps. The accessibility of drugs will be significantly improved, and joint treatment plans will be better connected between different hospitals.
Professor Qian Juying further emphasized that long-term effectiveness, multiple targets and sustainability have always been very important in blood lipid management. For patients with cardiovascular diseases such as ASCVD, doctors can follow the "Consensus" to give patients better treatment plans in the future, even if they are first diagnosed in primary hospitals. "For now, I think the combined treatment of statins and cholesterol absorption inhibitors is still a very reliable, safe and accessible combination treatment option in our blood lipid management. The widespread application of this solution in the future will be of great significance to the national blood lipid management and the reduction of ASCVD events."
