Can ezetimibe be given to a patient with elevated low-density lipoprotein (LDL) cholesterol who is also taking a statin (HMG-CoA reductase inhibitor)?

From the Guidelines

Yes, ezetimibe can be given to a patient with an LDL of 126 mg/dL who is already taking a statin, as the combination of ezetimibe and statin has been shown to provide an additional reduction in LDL levels and improve cardiovascular outcomes, as demonstrated in the IMPROVE-IT trial 1. The use of ezetimibe as an add-on therapy to statins is supported by recent guidelines, including the 2022 ACC expert consensus decision pathway, which recommends ezetimibe as a nonstatin agent for LDL-cholesterol lowering in the management of atherosclerotic cardiovascular disease risk 1. Key points to consider when adding ezetimibe to statin therapy include:

• Ensuring the patient is already on an optimized statin dose and has made appropriate lifestyle modifications
• Monitoring lipid levels and liver function tests regularly to assess efficacy and safety
• Being aware of potential drug-drug interactions, such as with cyclosporine, fibrates, and bile acid sequestrants
• Considering the patient's individual risk profile and cardiovascular disease status when making treatment decisions The IMPROVE-IT trial demonstrated that the addition of ezetimibe to simvastatin resulted in a significant reduction in cardiovascular events, particularly in high-risk patients 1. Additionally, a comparison of transatlantic approaches to lipid management found that both the AHA/ACC and ESC/EAS guidelines recommend ezetimibe as a second-line therapy in patients who are statin intolerant or do not achieve desired LDL-C lowering with maximally tolerated statin therapy 1.

From the FDA Drug Label

• In combination with a statin, or alone when additional low density lipoprotein cholesterol (LDL-C) lowering therapy is not possible, as an adjunct to diet to reduce elevated LDL-C in adults with primary hyperlipidemia, including heterozygous familial hypercholesterolemia (HeFH)

The patient has an LDL of 126, which is considered elevated. Ezetimibe can be given to a patient with elevated LDL-C in combination with a statin. Since the patient is already taking a statin, ezetimibe can be used as an adjunct to diet to further reduce LDL-C levels 2. Key points to consider:

• The patient's LDL level is elevated
• The patient is already taking a statin
• Ezetimibe can be used in combination with a statin to reduce LDL-C levels The use of ezetimibe in this patient is supported by the drug label.

From the Research

Ezetimibe Administration with Statin Therapy

• Ezetimibe can be given to a patient with LDL of 126 who is also taking statin, as it has been shown to lead to additional LDL cholesterol reduction and decreased ASCVD risk when added to statin therapy 3.
• The use of ezetimibe in combination with statin therapy is recommended for patients who require additional LDL cholesterol reduction and have a high risk of cardiovascular events 4.
• Studies have demonstrated that ezetimibe added to simvastatin, atorvastatin, or rosuvastatin therapy results in greater LDL-C reductions and goal attainment compared to titrating statin monotherapy 5.

Safety and Efficacy of Ezetimibe with Statin Therapy

• Ezetimibe has been shown to be safe and effective when used in combination with statin therapy, with no significant increase in adverse events 3, 5.
• The addition of ezetimibe to high-intensity statin therapy has been found to improve lipid profiles and reduce arterial stiffness in patients with familial hypercholesterolemia 6.
• Ezetimibe has been found to be effective in reducing LDL-C levels and achieving LDL-C goals in patients with high cardiovascular risk, particularly when used in combination with statin therapy 4, 5.

Considerations for Ezetimibe Administration

• The decision to add ezetimibe to statin therapy should be based on individual patient factors, including LDL-C levels, cardiovascular risk, and tolerability of statin therapy 4.
• Ezetimibe can be considered as an alternative to increasing statin intensity or adding other lipid-lowering agents, particularly in patients who experience adverse effects with statin therapy 3.
• The efficacy and safety of ezetimibe in combination with statin therapy have been demonstrated in several studies, supporting its use as a treatment option for patients with high cardiovascular risk 3, 4, 5, 6.