Which medication would you consider for a patient who has not achieved LDL goals on a statin?

Ezetimibe is a medication that effectively lowers LDL cholesterol by decreasing intestinal absorption of cholesterol. It acts at the brush border of the small intestine, inhibiting the transport of cholesterol and plant sterols into the enterocyte. In individuals who are already on a statin but have not reached their LDL cholesterol goals, adding ezetimibe can provide a complementary effect, further reducing LDL levels and improving overall lipid profiles.

Ezetimibe is particularly suitable for patients who may experience side effects from higher doses of statins or who may be at an increased risk of cardiovascular disease. Clinical studies have demonstrated that the combination of an ezetimibe with a statin not only lowers LDL cholesterol more effectively than using a statin alone but also has been shown to reduce the risk of major adverse cardiovascular events.

Other lipid-lowering agents listed, while effective in certain scenarios, are not the first-line choice for managing patients who are already on statins but still not achieving LDL goals. Niacin primarily increases HDL and may not significantly lower LDL. Omega-3 fatty acids are more effective for lowering triglycerides rather than LDL. Fibrates can lower triglycerides and have some modest effects on LDL but are not typically combined with statins due to increased risk