Abstract
Ezetimibe represents an effective and safe option to enhance LDL-C lowering efficacy of statins. It can be combined with any statin and in case of statin intolerance also with non-statin lipid-lowering agents.
Its use in the Czech Republic is still relatively limited despite the fact a large number of treated patients does not achieve LDL-C target levels. Its mechanism of action e.g. selective blockage of NPC1L1 cholesterol transport protein in the brush border of the enterocytes leads to 20% LDL-C lowering additional to the efficacy of any of co-administered statins.
As ezetimibe has been in use for quite some time its efficacy can be evidenced by many clinical trials among which the IMPROVE-IT study represents the most complex and important. The trial has particularly well documented the predicted benefit of statin-ezetimibe combo in the highest risk patients' groups, namely patients with type 2 diabetes.
These benefit from the therapy at least twice as much as non-diabetics. However, given the fact all the participants of the IMPROVE-IT trial were treated to very satisfactory LDL-C levels we may continue to recommend ezetimibe to be added to statin in all the patients who, despite being treated with an adequate statin dose, do not achieve LDL-C target concentrations.