Background: Clinical trials suggest ezetimibe lowers low-density lipoprotein cholesterol (LDL-C) by 10-20% when added to statins. In clinical practice, poor responders to statins may be ezetimibe high responders.

Methods: Prospectively, in a private practice setting, ezetimibe was given if LDL-C targets were reached on maximum (top dose or intolerant) statin therapy. Bloods were repeated at least 4 weeks after starting ezetimibe. The study lasted 24 months until 5th March 2010. All other drug therapy remained unchanged.

Results: 35 patients (mean age 70 years, 29 males) were included in the study. 17 patients (MR) were on maximally recommended statin dose, 18 patients (SI) could only tolerate small doses. All participants had reduction in LDL-C at follow-up. The average reduction was 31% (range 5.5%-50.5%; SD 10.6%). There was similar reduction in MR and SI patients. No new adverse effects were reported by the participants.

Conclusion: The addition of ezetimibe to patients on maximum recommended or tolerated dose produced a greater LDL-C reduction then the anticipated from the published literature. This may be due to patient selection of poor statin responders (PBS criteria). However the SI patients had similar response.