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In a patient with high cholesterol on atorvastatin, which drug is beneficial for cardiovascular disease prevention when added to statin therapy?

  1. Cholestyramine

  2. Ezetimibe

  3. Fenofibrate

  4. Niacin

The correct answer is: Ezetimibe

The addition of ezetimibe to atorvastatin therapy has shown significant benefits in reducing cardiovascular events in patients with high cholesterol. Ezetimibe works by inhibiting the absorption of cholesterol from the intestine, which complements the action of statins that primarily work by reducing cholesterol synthesis in the liver. This dual approach effectively lowers LDL cholesterol levels more than statin therapy alone. Clinical trials, such as the IMPROVE-IT trial, have specifically demonstrated that adding ezetimibe to statin therapy results in a further decrease in the risk of cardiovascular events, highlighting its role in cardiovascular disease prevention. Therefore, combining ezetimibe with atorvastatin is an evidence-based strategy to enhance lipid management and reduce cardiovascular risk in patients with elevated cholesterol levels. Other options, while they may have cholesterol-lowering effects, do not have the same level of evidence supporting their combination with statins for cardiovascular disease prevention. For example, cholestyramine is a bile acid sequestrant that can help lower cholesterol but often isn't used alongside statins due to GI side effects and less evidence for reducing cardiovascular events when added. Fenofibrate is mainly used to target triglycerides and has not consistently shown cardiovascular benefit when combined with statins, particularly in patients