06 Sep Cholesterol Management: When Should Ezetemibe Be Used?

Ezetemibe inhibits cholesterol absorption in the intestine. Used alone it has a modest effect on LDL cholesterol. When combined with even a low dose of a statin, substantial LDL reduction occurs.

Recently, a randomized trial of 17,000 patients, with an acute coronary syndrome, showed the combination of ezetemibe to simvastatin was slightly superior to simvastatin alone. This result was driven by a modest reduction in nonfatal MI especially in diabetic subjects. The absolute additional benefit of ezetemibe was small. Its unknown if a similar benefit occurs in patients without known disease or with stable atherosclerosis.

In secondary prevention it is reasonable to use Ezetemibe if (1) the target LDL is not reached with a statin. (2) Statin side effects necessitates a reduction in dose and the LDL is unsatisfactory on the lower dose (3) totally statin intolerant patients

In primary prevention the role of ezetemibe is questionable. There are no outcome studies and the likely benefit is very small or nothing except in the very highest risk patients e.g. familial hyperlipidemia with other additional risk factors and persistently high LDL despite maximum statin.

Ezetemibe is easy to use and prescribe. The dose is the same in everyone – 10mg. Side effects are uncommon. A CHEM number application can be done by any practitioner and just requires the patient to be at high risk and have failed a statin.

CLICK HERE to read the full study.