Ezetimibe 

• The prevention of cardiovascular disease is critically dependent on lipid-lowering therapy including statins, cholesterol absorption inhibitors, fibrates, and nicotinic acid.

• Statin therapy is widely used and well tolerated by the majority of patients. Statins are the most prescribed drugs in lipid lowering therapy but almost one third of the patients do not meet their treatment goals. Addition of ezetimibe can lower the LDL by an additional 18-20%, similar to that of doubling the dose of a statin two-three times. However, outcome trials demonstrating the benefits of lowering LDL-C with ezetimibe are still awaited.

• The Improved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT), involving 18,000 patients after acute coronary syndrome, is examining whether the addition of ezetimibe to statin would provide additional benefit for cardiovascular outcome.

• In the mean time ezetimibe is used among those who fail to reach the LDL goals with statin and other lipid optimizing therapy.