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The Ezetimibe Protocol

The Ezetimibe Protocol

$49.00 USD
$49.00 USD
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Ezetimibe is a secondary drug that can be added to your statin protocol to further reduce your LDL without increasing your statin dose. We would do this to reduce your LDL when your ten-year CVD risk is low. Ezetimibe has a low side effect profile and a combination with statins can lower LDL more effectively than significant increase in statin dose.

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What is Ezetimibe?

Like statins Ezetimibe is a drug that reduces LDL levels in your bloodstream. Unlike statins they work in your intestine rather than in your liver, so they don't have to be absorbed into your body.

Not having to be absorbed into your body means that Ezetimibe has less side effects than other drugs. Research shows that adding Ezetimibe to a statin protocol can sometimes decrease cholesterol levels by more than just increasing the statin does and can do it without increasing the likelihood of side effects.

At The Cholesterol Company, we try to use Ezetimibe to decrease LDL levels if your current risk is low before graduating to a more aggresive statin protocol.

Your First Step is Knowing Your Levels

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    Our Cholesterol Test tests ApoB, which is the single most important marker of dangerous cholesterol, but not tested by most doctors. Starting with our test, we'll craft you a tailored risk reduction plan.

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  • Upload Your Own Test Results

    If you have your own test results, you can them to receive a recommendation and protocol. Don't worry if your test doesn't have ApoB, we'll test it next time.

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How does Ezetimibe Work?

Your body gets rid of cholesterol via your intestine in your stool. Some amount of it will be re-absorbed into your body by a protein called the "Niemann-Pick C1-like 1 transporter".

Ezetimibe blocks the Niemann-Pick C1-like 1 transporter so your body can't reabsorb cholesterol. Similarly to statins this lowers the cholesterol levels in your liver, causing it to absorb more LDL out of the blood lowering LDL levels.

Unlike statins, ezetimibe doesn't seem to have any secondary benefits beyond lowering LDL. For this reason we like to start everyone with a low dose statin before adding ezetimibe to further lower cholesterol.

FAQs

What side effects does ezetimibe have?

Since ezetimibe acts in your intestine it can give you an upset stomach or diarrhea.

Occasionally ezetimibe users will also report fatigue. All side effects stop if ezetimibe usage is discontinued.

Can Ezetimibe we used as a standalone treatment?

We typically don't use ezetimibe as a standalone treatment because statins offer secondary benefits, and are more potent at lowering LDL.

If statins cause too many side-effects we can use ezetimibe as a standalone treatment if your risk is currently very low and you're relatively young. If that's not the case, you're likely in a position your PCP will help you engage in other cholesterol lowering drugs like Bempedoic acid or PCSK9 inhibitors.

Why don't you prescribe PCSK9 inhibitors or Bempedoic acid?

Both drugs are still under patent and are extremely expensive.

PCSK9 inhibitors also require you to go to a treatment center for regular injections. For most patients statins and Ezetimibe are the right treatments, and if they're not we'll arm you with as much evidence as possible to get more advanced treatments from your PCP.

What are the benefits of adding ezetimibe to a statin therapy?

Ezetimibe can offer significant additional lowering of dangerous LDL in your blood without increasing the likelihood of any side effects.

Can lifestyle changes be enough to manage high cholesterol, or are medications necessary?

Lifestyle can change cardiac risk, but even in the few cases that patients can are able to lower cholesterol it's rarely sufficient.

We'll never recommend medication if you don't need it. We also don't recommend continuing to take even another month of damage to your arteries that may potentially lead to a fatal heart attack when a safe drug could stop it.

How often should I retest my cholesterol levels?

We will suggest a retest cadence and follow up by email when it's time to take another test.

Generally we like to test every two months until we hit target cholesterol levels, and then retest less frequently afterwards.