Zetia is the brand name for the drug ezetimibe. It is the first of a new class of cholesterol-lowering medications. Zetia is not a statin. Statins lower cholesterol by preventing the liver from synthesizing new cholesterol, while Zetia lowers cholesterol by preventing the intestine from absorbing cholesterol into the blood stream.
Low-density lipoprotein, or LDL, is nicknamed “bad cholesterol.” These particles, which are made of protein and cholesterol molecules, carry cholesterol from the liver to the body tissues that need it. As these particles circulate, however, they can stick to the walls of the blood vessels and form plaque. HDL, or high-density lipoprotein, is the “good cholesterol.” It picks up LDL and carries it back to the liver. High LDL levels and low HDL levels are among the risk factors for heart attack and stroke.
Zetia works in the intestines. It blocks the function of the protein that carries cholesterol through the wall of the intestine and into the blood stream. Zetia blocks the absorption of the cholesterol you eat, but still lowers cholesterol of those who adhere to a low cholesterol diet. Since digestive bile is also composed of cholesterol, it blocks the absorption of that cholesterol as well. The cholesterol is then expelled through the feces. This requires the liver to pull more cholesterol out of the blood stream.
Zetia lowers LDL cholesterol an average of 18 percent. It also lowers LDL better than niacin. Since it works differently than statin drugs, you can take Zetia with a statin if your cholesterol is not lowered enough on a statin alone.
Although studies show that Zetia is effective in lowering LDL cholesterol, some research shows that it may not effect the thickening of arterial walls, or atherosclerosis. In 2008, the ENHANCE study showed that the combination of ezetimibe with simvastatin was no more effective in reducing atherosclerosis than simvastatin alone. Many patients questioned the benefit of Zetia after hearing news reports about the study. Some experts point out that while Zetia may not be as effective in reducing atherosclerosis, no studies have examined its effectiveness in preventing heart attack and stroke. The connection between cholesterol levels and heart disease is complex. One theory is that Zetia does not increase the “good” HDL cholesterol as well as some of the drugs it has been compared with.
Like statins, Zetia can cause muscle pain in some people. If you experience muscle pain or weakness while taking Zetia, you should contact your doctor. Some news reports have indicated that Zetia is harmful to the liver, but the risk of liver damage with Zetia is rare, and no more likely than with a statin. You doctor may want to do a blood test to check your liver enzymes before you begin to take Zetia.
- Pharmist's Letter/Prescriber's Letter; Does Ezetimibe ENHANCE Lipid Therapy: More Information From the ENHANCE Trial; May 2008
- Heartwire; ARBITER 6-HALTS: HDL Raising With Niacin Superior to Ezetimibe; Michal Riordan; November 15, 2009
- Zetia Prescribing Information