Ezetimibe

Also known as: Zetia (brand), cholesterol absorption inhibitor

Other

In plain English

Ezetimibe is a cholesterol-lowering pill that blocks cholesterol absorption from the gut. It is often added to a statin (or used alone if statins aren't tolerated) to push LDL ('bad' cholesterol) lower. Adding it to a statin after a heart event has been shown to further reduce cardiovascular events. It is generally well tolerated.

The science

Ezetimibe inhibits the Niemann-Pick C1-like 1 (NPC1L1) sterol transporter at the intestinal brush border, reducing cholesterol absorption and lowering LDL cholesterol by roughly 15-24% as add-on therapy. In the IMPROVE-IT trial (18,144 post-acute-coronary-syndrome patients), adding ezetimibe to simvastatin further lowered LDL and reduced the composite of cardiovascular death, MI, unstable angina, revascularization, or stroke.

References

• Cannon CP et al., ezetimibe added to statin therapy after ACS (IMPROVE-IT), N Engl J Med 2015
• Grundy SM et al., 2018 AHA/ACC/multisociety guideline on blood cholesterol, Circulation 2019