Ezetimibe is a once-daily oral prescription medication that lowers harmful cholesterol by blocking its uptake in the gut. It lowers this cholesterol alone and adds a further drop on top of a statin. Large trials, mainly in people with heart disease, show modestly fewer heart attacks and strokes, not fewer deaths. Side effects are generally mild; a small, possible bowel-cancer risk remains unresolved. Evidence in younger, healthy adults is thinner. (Full Review)
| Marker | Target | Why |
|---|---|---|
| LDL cholesterol | Below 55 mg/dL (very high risk) or below 70 mg/dL (established atherosclerotic disease) | Primary target |
| ApoB | Below 65 mg/dL (very high risk) or below 80 mg/dL (high risk) | Counts plaque-forming particles |
| Non-HDL cholesterol | Below 85 mg/dL (very high risk) | Captures all plaque-forming cholesterol |
| ALT and AST | About 7–55 U/L, varies by laboratory | Safety check; persistent rise to at least 3× the upper limit of normal prompts withdrawal |
| Creatine kinase | About 30–200 U/L, varies by laboratory and sex | Safety check; elevation with muscle symptoms prompts stopping |
| Sitosterol and campesterol | No established target; track change from the individual's own baseline | Mark cholesterol absorption; identify hyper-absorbers |
Cadence: Baseline lipid panel with apoB and liver enzymes; lipids and apoB at 4–12 weeks after starting or changing therapy, then every 6–12 months once targets are met; liver enzymes at 4–12 weeks with a statin, then as clinically indicated; creatine kinase only if muscle symptoms appear