Ezetimibe Prescribing Guidelines

Primary Indications for Ezetimibe

• The American College of Cardiology recommends adding ezetimibe to maximally tolerated statin therapy when LDL-C remains ≥70 mg/dL in very high-risk patients with clinical atherosclerotic cardiovascular disease (ASCVD) 1, 2
• The American College of Cardiology suggests ezetimibe as a Class IIa recommendation with Level B evidence for patients with clinical ASCVD on maximally tolerated statin therapy 1, 2
• The BMJ guideline recommends ezetimibe as the preferred first add-on therapy before considering PCSK9 inhibitors due to lower cost 3
• The European Heart Journal expert consensus strongly supports combination therapy with ezetimibe and statins for reducing LDL-C and cardiovascular events 4, 5

Secondary Prevention and Primary Prevention

• The American College of Cardiology recommends adding ezetimibe when patients achieve less than 50% reduction in LDL-C on maximally tolerated statin therapy and/or have LDL-C ≥100 mg/dL despite statin treatment for patients aged 20-75 years with LDL-C ≥190 mg/dL 1, 2
• The American College of Cardiology suggests ezetimibe as a Class IIa recommendation with Level B evidence for primary prevention in patients with severe hypercholesterolemia 1, 2

Diabetes with High Cardiovascular Risk

• The American Diabetes Association considers adding ezetimibe to maximally tolerated statin therapy to reduce LDL-C by 50% or more for adults with diabetes and 10-year ASCVD risk ≥20% 6
• The American Diabetes Association suggests ezetimibe as a Class IIb recommendation with Level C evidence for patients with diabetes and high cardiovascular risk 6

Statin-Intolerant Patients

• The AHA/ACC guidelines classify ezetimibe as a Class IIb recommendation for patients who cannot tolerate statins 8, 9

Expected Efficacy and Practical Prescribing Considerations

• The European expert panel found that ezetimibe added to stable rosuvastatin produced greater improvements in lipid profile with better LDL-C goal achievement compared to up-titration of rosuvastatin alone 4, 5
• The International Lipid Expert Panel emphasizes initiating combination therapy early in highest-risk patients, rather than sequential stepwise intensification 10