An oral medication that blocks the intestine from absorbing cholesterol, including the large amount recycled through bile. Modest lowering of harmful blood cholesterol alone; substantially more when added to a statin. Fewer heart attacks and strokes in people with existing heart disease, kidney disease, or advanced age, though not longer survival. Cheap, once daily, well tolerated, lifelong. (Full Review)
| Marker | Target | Why |
|---|---|---|
| LDL cholesterol | Below 70 mg/dL generally; below 55 mg/dL with established artery disease; many longevity-oriented practitioners target below 50 mg/dL | The primary treatment target and the variable the drug directly changes |
| Apolipoprotein B (ApoB) | Below 80 mg/dL generally; below 60 mg/dL at high risk | Counts atherogenic particles directly rather than the cholesterol they carry, and catches discordance with LDL |
| Non-HDL cholesterol | Below 100 mg/dL generally; below 85 mg/dL at high risk | Captures all cholesterol in atherogenic particles, including remnants that calculated LDL misses |
| Lipoprotein(a) | Below 30 mg/dL, or below 75 nmol/L | Identifies genetically driven residual risk that ezetimibe does not touch |
| ALT and AST | ALT below 25 U/L in men and below 20 U/L in women; AST similar | Detects the one laboratory abnormality with a demonstrated excess on statin-ezetimibe combinations |
| Creatine kinase (CK) | Below 200 U/L, interpreted against the individual's own baseline | Distinguishes true drug-related muscle injury from exercise-induced elevation when muscle symptoms appear |
| High-sensitivity C-reactive protein (hs-CRP) | Below 1.0 mg/L | Tracks residual inflammatory risk, which persists independently of how low LDL goes |
| Fasting glucose and HbA1c | Fasting glucose 75–85 mg/dL; HbA1c below 5.4% | Monitors the diabetes risk contributed by the statin partner, which ezetimibe itself does not carry |
| Serum campesterol, sitosterol, lathosterol, desmosterol | Interpreted as ratios to total cholesterol rather than absolute values | Distinguishes hyper-absorbers, who respond well to ezetimibe, from hyper-synthesizers, who respond better to statins |
Cadence: Lipid panel and apolipoprotein B at 4–8 weeks after starting or any dose change; liver enzymes at 8–12 weeks whenever a statin is co-prescribed; then every 6–12 months once values are stable; creatine kinase only if muscle symptoms appear; lipoprotein(a) once in a lifetime.