Most of my patients let me know they would rather not take medications to lower their cholesterol. “Hey Dr. DeVane, I don’t want more pills, can’t I just work on my diet and exercise to get my numbers down.”
I get it! No one wants to take meds. But, my goal in life is to keep you around for a really long time and to protect you from having heart EVENTS- like heart attacks and, of course, death.
If you are at high risk for heart events or have already had an event like a heart attack, coronary stent or positive coronary artery calcium score, then we need to be really aggressive at keeping your arteries healthy. We are targeting your “bad” cholesterol, the LDL-C.
So, I may have you taking a medication called Zetia- most likely along with a statin medication.
“Let’s get your LDL-C DOWN to help PROTECT YOU!!!! “ – Dr. DeVane
I thought it would be nice to give you a bit of a Zetia overview here and why you are taking it.
What is Zetia?
Ezetimibe is a cholesterol lowering medication marketed under the brand name Zetia. It is a medication that came to market in 2002 and has become a great, effective and safe tool for cardiologists to help lower your cholesterol. It is taken once a day and just comes in one dose: 10mg.
How Does Zetia Work?
Zetia has a unique mechanism to help lower your cholesterol levels. It is completely different from the statin drugs which allows it to complement nicely with statins when used together.
Zetia is a cholesterol absorption inhibitor. It blocks LDL-C uptake at your jejunal enterocyte brush border by targeting the cholesterol transport protein called Nieman Pick C1-like protein.
Uhhhh- what?
In other words, Zetia blocks bad cholesterol absorption in your gut.
It turns out that statins actually cause increased intestinal absorption of LDL-C cholesterol, so blocking this absorption with Zetia (in combination with a statin) makes a lot of sense.
Three Scenarios I Use Zetia
- Combo treatment out of the gate
More often these days I am just using a combination of a statin plus Zetia right from the start. This helps us use a lower dose of the statin while still obtaining great LDL-C lowering.
2. Not meeting LDL-C goal
The lower your LDL-C the better! The data tells us to get your LDL-C down to 40s or 50s if you are at high risk or already have heart disease. One type of medication alone will probably not get us to your target. That’s why combo meds are so nice.
3. Statin intolerant
Some of you have side effects or intolerances to the statin meds. Some people tolerate 10 or 20mg of a statin but not 40 or 80mg. Using a combo med approach allows us to minimize your statin dose while still getting your LDL-C down nicely.
Some of the Great Reasons I Use Zetia
Enhanced LDL-C Lowering: The combination of Zetia plus a statin has been shown to provide a much greater reduction in LDL-C levels compared to statin therapy alone.
Complementary Mechanism of Action: Statins lower LDL-C by decreasing cholesterol synthesis in your liver. Zetia works by blocking cholesterol absorption in your GI tract. This complementary approach enhances LDL-C lowering by addressing both cholesterol absorption and production.
Tolerability and Safety: Zetia has been around for more than 20 years and it is extremely well tolerated and is very safe to use either alone or in combination with a statin medication.
Cardiovascular Outcomes Studies: We love data and scientific trials to help guide our treatment decisions. The IMPROVE-IT trial was a game changer for treating cholesterol in people who were recovering from a heart event (acute coronary syndrome). This trial showed that adding Zetia to statin therapy alone led to;
- improved CV outcomes,
- less bad CV events and,
- improved biomarkers of risk along with coronary plaque regression.
Conclusions
I really want to help you get your bad cholesterol levels down as low as we can to prevent anything bad from happening to your heart. Of course, a great mediterranean-style diet, regular exercise and weight control are keys to any prevention plan. However- meds REALLY WORK AT PROTECTING YOU.
We are going to do this by aggressive LDL-C lowering and this may require a combination of medications to get us there. Zetia added to a statin medication (or other cholesterol lowering medications) offers a complimentary mechanism of action to lower LDL-C, enhanced cholerterol lowering and incredible cardiovascular benefits in clinical trials. It’s very safe to use, once daily, inexpensive and it works.
I look forward to seeing your next cholesterol labs as we get you to our target goals!
