From the Guidelines
Ezetimibe is a recommended treatment option for patients with acute coronary syndromes, particularly those with statin intolerance, as it has been shown to reduce LDL-C levels by 15% to 25% and decrease the risk of major adverse cardiovascular events (MACE) by 6.4%. According to the 2025 ACC/AHA/ACEP/NAEMSP/SCAI guideline for the management of patients with acute coronary syndromes 1, ezetimibe is a safe and well-tolerated option for patients with complete or partial intolerance to statin therapy. The IMPROVE IT trial, cited in the guideline, demonstrated that the addition of ezetimibe to simvastatin reduced the relative risk of MACE by 6.4% compared with placebo over a median of 6 years’ follow-up 1.
Key points to consider when prescribing ezetimibe include:
- The standard dosage is 10 mg once daily, taken with or without food 1
- Ezetimibe can be used as monotherapy for patients who cannot tolerate statins or as adjunct therapy alongside statins for patients who cannot achieve target LDL cholesterol levels with statins alone 1
- The medication is generally well-tolerated with minimal side effects, which may include mild gastrointestinal symptoms, headache, and rarely, muscle pain 1
- Regular lipid panel monitoring is recommended after initiating treatment to assess efficacy 1
Overall, ezetimibe is a valuable treatment option for patients with acute coronary syndromes, particularly those with statin intolerance, due to its ability to reduce LDL-C levels and decrease the risk of MACE.
From the FDA Drug Label
Ezetimibe Tablet reduces total-C, LDL-C, Apo B, and non-HDL-C in patients with hyperlipidemia. Maximal to near maximal response is generally achieved within 2 weeks and maintained during chronic therapy
Ezetimibe treatment reduces total-C, LDL-C, Apo B, and non-HDL-C in patients with hyperlipidemia. The maximal to near maximal response is generally achieved within 2 weeks and maintained during chronic therapy 2.
- Key benefits of ezetimibe treatment:
- Reduces total-C
- Reduces LDL-C
- Reduces Apo B
- Reduces non-HDL-C
- Time to maximal response: 2 weeks
- Duration of response: maintained during chronic therapy
From the Research
Ezetimibe Treatment Efficacy
- Ezetimibe is a cholesterol absorption inhibitor that can be used as monotherapy or in combination with statins to lower low-density lipoprotein cholesterol (LDL-C) levels 3.
- Studies have shown that ezetimibe co-administered with atorvastatin provides significant incremental reductions in LDL-C levels compared to atorvastatin monotherapy 4, 5.
- The addition of ezetimibe to simvastatin, atorvastatin, or rosuvastatin monotherapy has been shown to result in greater reductions in LDL-C levels compared to doubling the statin dose 6.
Ezetimibe Treatment Safety
- Ezetimibe has a favorable pharmacokinetic profile and is generally well tolerated, with a safety profile comparable to that of placebo 3.
- The combination of ezetimibe with atorvastatin has been shown to have a safety and tolerability profile similar to that of atorvastatin alone 5.
- Previous concerns about a possible increase in the incidence of cancer with ezetimibe were dismissed in large trials with long follow-up periods 4.
Ezetimibe Treatment Outcomes
- Ezetimibe therapy has been shown to significantly improve the lipid profile, including reductions in LDL-C and total cholesterol levels, without disturbing glucose metabolism 7.
- The proportion of patients achieving their target LDL-C level goal was significantly higher with ezetimibe co-administered with atorvastatin compared to atorvastatin monotherapy 5.
- Ezetimibe co-administered with atorvastatin has been shown to induce the regression of coronary atherosclerosis measured by intravascular ultrasound in a significantly greater proportion of patients than atorvastatin alone 4.