ezetimibe + simvastatin + fenofibrate

A combination of three small-molecule drugs—**ezetimibe**, **simvastatin**, and **fenofibrate**—used for the treatment of mixed hyperlipidemia. - **Ezetimibe** is a selective cholesterol absorption inhibitor that blocks the Niemann-Pick C1-like 1 (NPC1L1) protein in the jejunal brush border, reducing intestinal absorption of cholesterol and lowering LDL-C levels. - **Simvastatin** is an HMG-CoA reductase inhibitor (statin) that reduces cholesterol synthesis in the liver, further lowering LDL-C and total cholesterol. - **Fenofibrate** is a fibric acid derivative that acts as an agonist of peroxisome proliferator-activated receptor alpha (PPARα), reducing triglyceride levels and increasing HDL-C levels while decreasing small, dense LDL-C fractions. The triple combination has shown synergistic or additive effects in improving the atherogenic lipid profile, with significant reductions in LDL-C, non-HDL-C, total cholesterol, and triglycerides, and increases in HDL-C, especially beneficial in mixed (combined) dyslipidemia, including in type 2 diabetes. The combination can convert LDL particle sizes from small, dense (atherogenic) forms to larger, more buoyant, less atherogenic profiles, and improve vascular function. Clinical data support effectiveness and safety for the management of atherogenic mixed hyperlipidemia and secondary cardiovascular prevention[1][2][3][4][5].