Ezetimibe

Ezetimibe is a cholesterol pill that is not a statin. It works by reducing how much cholesterol the gut absorbs. In IMPROVE-IT, adding it to a statin after an acute coronary syndrome lowered LDL cholesterol further and gave a small extra reduction in heart and blood-vessel events.

Also called Zetia

Drug
In this atlas

Overview

Technical summary

RxNorm ingredient 341248. The IMPROVE-IT abstract describes it as a nonstatin drug that reduces intestinal cholesterol absorption. The evidence recorded is the combination with simvastatin; ezetimibe alone is not tested in this atlas.

About this drug

Level: Substance
Mechanism: Reduces intestinal cholesterol absorption (IMPROVE-IT abstract)

Claims and evidence

Context Adults hospitalised for an acute coronary syndrome in the previous 10 days with LDL cholesterol 50 to 100 mg/dL on lipid-lowering therapy (IMPROVE-IT)

Recipient: Adult
Population: Patients hospitalised for an acute coronary syndrome within the preceding 10 days, with LDL cholesterol 50 to 100 mg/dL if on lipid-lowering therapy or 50 to 125 mg/dL if not (abstract). The registry gives a minimum age of 18 years and all sexes.
Care setting: Hospital-recruited patients followed in a multicentre trial (abstract). Site list not read.
Geography: Not stated in the source (abstract). The registry record lists no countries.
Life stage: Adult, 18 years and older (registry minimum age)
Follow-up: Median follow-up 6 years (abstract). The registry gives up to approximately 9 years as the outcome time frame.

Eligibility: 2 inclusion criteria; exclusion criteria not stated

Included: Hospitalised for an acute coronary syndrome in the preceding 10 days
LDL cholesterol 50 to 100 mg per deciliter if receiving lipid-lowering therapy, or 50 to 125 mg per deciliter if not (abstract)
Excluded: None stated

Effect Interventional Certainty not assessed

In IMPROVE-IT, 18,144 patients hospitalised for an acute coronary syndrome in the previous 10 days received simvastatin 40 mg with ezetimibe 10 mg or simvastatin 40 mg with placebo. The median time-weighted LDL cholesterol was 53.7 mg/dL with ezetimibe added and 69.5 mg/dL with simvastatin alone. At 7 years the Kaplan-Meier rate of the primary composite end point was 32.7% with ezetimibe and 34.7% with simvastatin alone (absolute difference 2.0 percentage points; hazard ratio 0.936, 95% CI 0.89 to 0.99; P=0.016). The abstract says muscle, gallbladder and hepatic adverse effects and cancer were similar in the two groups.
Applies to Adult
- Patients hospitalised for an acute coronary syndrome within the preceding 10 days, with LDL cholesterol 50 to 100 mg/dL if on lipid-lowering therapy or 50 to 125 mg/dL if not (abstract). The registry gives a minimum age of 18 years and all sexes.
- Hospital-recruited patients followed in a multicentre trial (abstract). Site list not read.
- Not stated in the source (abstract). The registry record lists no countries.
- Adult, 18 years and older (registry minimum age)
Follow-up Median follow-up 6 years (abstract). The registry gives up to approximately 9 years as the outcome time frame.
Certainty method
Not assessed

Limitations
One randomised trial, double-blind, funded by Merck according to the abstract. The benefit is modest in absolute terms (2.0 percentage points at 7 years). The population was people after an acute coronary syndrome who took simvastatin 40 mg; the result is for adding ezetimibe to that statin, not for ezetimibe alone. Abstract only; the registry record lists Organon and Co as its current lead sponsor.

Last checked
2026-10-14

Next evidence check due
Not scheduled
Sources and citations (14)
1. Supports Ezetimibe Added to Statin Therapy after Acute Coronary Syndromes
  
  Publication · The New England journal of medicine · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched. · Published 2015-06-18 · DOI: 10.1056/NEJMoa1410489 · PMID: 26039521
  
  Locator
  Abstract, METHODS, sentence 1, fragment 1 of 4: "We conducted a double-blind, randomized trial involving 18,144 patients who had been hospitalized for an acute coronary syndrome within the preceding 10 days and"
  
  How it applies
  Abstract of the paper from PubMed; the full text was not read.
  
  Retrieved
  2026-10-14T18:18:31Z
  
  Source effective date
  Not reported
  
  Source state
  Current
  
  Snapshot hash
  95ed7a7bcbbe090b707e2d1472e160f007bde63f724c65c03b53fb9cbcb93d57
  
  Reuse basis
  PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
2. Supports Ezetimibe Added to Statin Therapy after Acute Coronary Syndromes
  
  Publication · The New England journal of medicine · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched. · Published 2015-06-18 · DOI: 10.1056/NEJMoa1410489 · PMID: 26039521
  
  Locator
  Abstract, METHODS, sentence 1, fragment 2 of 4: "had LDL cholesterol levels of 50 to 100 mg per deciliter (1.3 to 2.6 mmol per liter)"
  
  How it applies
  LDL entry range on lipid-lowering therapy.
  
  Retrieved
  2026-10-14T18:18:31Z
  
  Source effective date
  Not reported
  
  Source state
  Current
  
  Snapshot hash
  95ed7a7bcbbe090b707e2d1472e160f007bde63f724c65c03b53fb9cbcb93d57
  
  Reuse basis
  PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
3. Supports Ezetimibe Added to Statin Therapy after Acute Coronary Syndromes
  
  Publication · The New England journal of medicine · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched. · Published 2015-06-18 · DOI: 10.1056/NEJMoa1410489 · PMID: 26039521
  
  Locator
  Abstract, METHODS, sentence 1, fragment 3 of 4: "if they were receiving lipid-lowering therapy or 50 to 125 mg per deciliter (1.3 to 3.2 mmol per liter)"
  
  How it applies
  LDL entry range when not on lipid-lowering therapy.
  
  Retrieved
  2026-10-14T18:18:31Z
  
  Source effective date
  Not reported
  
  Source state
  Current
  
  Snapshot hash
  95ed7a7bcbbe090b707e2d1472e160f007bde63f724c65c03b53fb9cbcb93d57
  
  Reuse basis
  PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
4. Supports Ezetimibe Added to Statin Therapy after Acute Coronary Syndromes
  
  Publication · The New England journal of medicine · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched. · Published 2015-06-18 · DOI: 10.1056/NEJMoa1410489 · PMID: 26039521
  
  Locator
  Abstract, METHODS, sentence 2: "The combination of simvastatin (40 mg) and ezetimibe (10 mg) (simvastatin-ezetimibe) was compared with simvastatin (40 mg) and placebo (simvastatin monotherapy)."
  
  How it applies
  The two treatment arms.
  
  Retrieved
  2026-10-14T18:18:31Z
  
  Source effective date
  Not reported
  
  Source state
  Current
  
  Snapshot hash
  95ed7a7bcbbe090b707e2d1472e160f007bde63f724c65c03b53fb9cbcb93d57
  
  Reuse basis
  PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
5. Supports Ezetimibe Added to Statin Therapy after Acute Coronary Syndromes
  
  Publication · The New England journal of medicine · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched. · Published 2015-06-18 · DOI: 10.1056/NEJMoa1410489 · PMID: 26039521
  
  Locator
  Abstract, METHODS, sentence 3, fragment 1 of 2: "The primary end point was a composite of cardiovascular death, nonfatal myocardial infarction, unstable angina requiring rehospitalization, coronary revascularization (≥30 days after randomization),"
  
  How it applies
  Primary end point, first part.
  
  Retrieved
  2026-10-14T18:18:31Z
  
  Source effective date
  Not reported
  
  Source state
  Current
  
  Snapshot hash
  95ed7a7bcbbe090b707e2d1472e160f007bde63f724c65c03b53fb9cbcb93d57
  
  Reuse basis
  PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
6. Supports Ezetimibe Added to Statin Therapy after Acute Coronary Syndromes
  
  Publication · The New England journal of medicine · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched. · Published 2015-06-18 · DOI: 10.1056/NEJMoa1410489 · PMID: 26039521
  
  Locator
  Abstract, METHODS, sentence 3, fragment 2 of 2: "or nonfatal stroke."
  
  How it applies
  Primary end point, last part.
  
  Retrieved
  2026-10-14T18:18:31Z
  
  Source effective date
  Not reported
  
  Source state
  Current
  
  Snapshot hash
  95ed7a7bcbbe090b707e2d1472e160f007bde63f724c65c03b53fb9cbcb93d57
  
  Reuse basis
  PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
7. Supports Ezetimibe Added to Statin Therapy after Acute Coronary Syndromes
  
  Publication · The New England journal of medicine · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched. · Published 2015-06-18 · DOI: 10.1056/NEJMoa1410489 · PMID: 26039521
  
  Locator
  Abstract, METHODS, sentence 4: "The median follow-up was 6 years."
  
  How it applies
  Median follow-up.
  
  Retrieved
  2026-10-14T18:18:31Z
  
  Source effective date
  Not reported
  
  Source state
  Current
  
  Snapshot hash
  95ed7a7bcbbe090b707e2d1472e160f007bde63f724c65c03b53fb9cbcb93d57
  
  Reuse basis
  PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
8. Supports Ezetimibe Added to Statin Therapy after Acute Coronary Syndromes
  
  Publication · The New England journal of medicine · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched. · Published 2015-06-18 · DOI: 10.1056/NEJMoa1410489 · PMID: 26039521
  
  Locator
  Abstract, RESULTS, sentence 1, fragment 1 of 2: "The median time-weighted average LDL cholesterol level during the study was 53.7 mg per deciliter (1.4 mmol per liter) in the simvastatin-ezetimibe group,"
  
  How it applies
  Time-weighted LDL cholesterol, ezetimibe arm.
  
  Retrieved
  2026-10-14T18:18:31Z
  
  Source effective date
  Not reported
  
  Source state
  Current
  
  Snapshot hash
  95ed7a7bcbbe090b707e2d1472e160f007bde63f724c65c03b53fb9cbcb93d57
  
  Reuse basis
  PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
9. Supports Ezetimibe Added to Statin Therapy after Acute Coronary Syndromes
  
  Publication · The New England journal of medicine · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched. · Published 2015-06-18 · DOI: 10.1056/NEJMoa1410489 · PMID: 26039521
  
  Locator
  Abstract, RESULTS, sentence 1, fragment 2 of 2: "as compared with 69.5 mg per deciliter (1.8 mmol per liter) in the simvastatin-monotherapy group (P<0.001)."
  
  How it applies
  Time-weighted LDL cholesterol, simvastatin-alone arm.
  
  Retrieved
  2026-10-14T18:18:31Z
  
  Source effective date
  Not reported
  
  Source state
  Current
  
  Snapshot hash
  95ed7a7bcbbe090b707e2d1472e160f007bde63f724c65c03b53fb9cbcb93d57
  
  Reuse basis
  PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
10. Supports Ezetimibe Added to Statin Therapy after Acute Coronary Syndromes
  
  Publication · The New England journal of medicine · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched. · Published 2015-06-18 · DOI: 10.1056/NEJMoa1410489 · PMID: 26039521
  
  Locator
  Abstract, RESULTS, sentence 2, fragment 1 of 2: "The Kaplan-Meier event rate for the primary end point at 7 years was 32.7% in the simvastatin-ezetimibe group,"
  
  How it applies
  Kaplan-Meier event rate at 7 years, ezetimibe arm.
  
  Retrieved
  2026-10-14T18:18:31Z
  
  Source effective date
  Not reported
  
  Source state
  Current
  
  Snapshot hash
  95ed7a7bcbbe090b707e2d1472e160f007bde63f724c65c03b53fb9cbcb93d57
  
  Reuse basis
  PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
11. Supports Ezetimibe Added to Statin Therapy after Acute Coronary Syndromes
  
  Publication · The New England journal of medicine · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched. · Published 2015-06-18 · DOI: 10.1056/NEJMoa1410489 · PMID: 26039521
  
  Locator
  Abstract, RESULTS, sentence 2, fragment 2 of 2: "as compared with 34.7% in the simvastatin-monotherapy group (absolute risk difference, 2.0 percentage points; hazard ratio, 0.936; 95% confidence interval, 0.89 to 0.99; P=0.016)."
  
  How it applies
  Event rate, comparator arm, and hazard ratio.
  
  Retrieved
  2026-10-14T18:18:31Z
  
  Source effective date
  Not reported
  
  Source state
  Current
  
  Snapshot hash
  95ed7a7bcbbe090b707e2d1472e160f007bde63f724c65c03b53fb9cbcb93d57
  
  Reuse basis
  PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
12. Supports Ezetimibe Added to Statin Therapy after Acute Coronary Syndromes
  
  Publication · The New England journal of medicine · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched. · Published 2015-06-18 · DOI: 10.1056/NEJMoa1410489 · PMID: 26039521
  
  Locator
  Abstract, RESULTS, sentence 3: "Rates of prespecified muscle, gallbladder, and hepatic adverse effects and cancer were similar in the two groups."
  
  How it applies
  Adverse effects and cancer were similar.
  
  Retrieved
  2026-10-14T18:18:31Z
  
  Source effective date
  Not reported
  
  Source state
  Current
  
  Snapshot hash
  95ed7a7bcbbe090b707e2d1472e160f007bde63f724c65c03b53fb9cbcb93d57
  
  Reuse basis
  PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
13. Background Ezetimibe Added to Statin Therapy after Acute Coronary Syndromes
  
  Publication · The New England journal of medicine · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched. · Published 2015-06-18 · DOI: 10.1056/NEJMoa1410489 · PMID: 26039521
  
  Locator
  Abstract, CONCLUSIONS, sentence 3: "(Funded by Merck; IMPROVE-IT ClinicalTrials.gov number, NCT00202878.)."
  
  How it applies
  Funding note in the abstract.
  
  Retrieved
  2026-10-14T18:18:31Z
  
  Source effective date
  Not reported
  
  Source state
  Current
  
  Snapshot hash
  95ed7a7bcbbe090b707e2d1472e160f007bde63f724c65c03b53fb9cbcb93d57
  
  Reuse basis
  PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
14. Supports IMPROVE-IT: Examining Outcomes in Subjects With Acute Coronary Syndrome: Vytorin (Ezetimibe/Simvastatin) vs Simvastatin (P04103)
  
  Registry · U.S. National Library of Medicine (ClinicalTrials.gov) · Edition ClinicalTrials.gov API v2 record, last update posted 2024-06-18. · NCT: NCT00202878
  
  Locator
  protocolSection.designModule.enrollmentInfo.count: "18144"
  
  How it applies
  Registry enrollment count, equal to the abstract.
  
  Retrieved
  2026-10-14T18:18:31Z
  
  Source effective date
  2024-06-18
  
  Source state
  Current
  
  Snapshot hash
  591576a2ffb6fc2d9789d27fc116ad9587258642700ce74649121e0d84936c81
  
  Reuse basis
  Registry record. The raw API JSON is committed. The ClinicalTrials.gov terms page is rendered by JavaScript and its text was not read by a script, so the redistribution basis is unverified; any quotation stays short. The raw file is committed at research/snapshots/cg-ctgov-NCT00202878.json.

Clinical links

Each link reports what one cited claim says about one population. "Evaluated for" means studied, not shown to work. These links do not show that anything is effective or right for you.

Claim, not a settled fact Added to a statin after acute coronary syndrome: Coronary artery disease (Evaluated for)
Applies to Adult
- Patients hospitalised for an acute coronary syndrome within the preceding 10 days, with LDL cholesterol 50 to 100 mg/dL if on lipid-lowering therapy or 50 to 125 mg/dL if not (abstract). The registry gives a minimum age of 18 years and all sexes.
- Hospital-recruited patients followed in a multicentre trial (abstract). Site list not read.
- Not stated in the source (abstract). The registry record lists no countries.
- Adult, 18 years and older (registry minimum age)
Follow-up Median follow-up 6 years (abstract). The registry gives up to approximately 9 years as the outcome time frame.
In IMPROVE-IT, 18,144 patients hospitalised for an acute coronary syndrome in the previous 10 days received simvastatin 40 mg with ezetimibe 10 mg or simvastatin 40 mg with placebo. The median time-weighted LDL cholesterol was 53.7 mg/dL with ezetimibe added and 69.5 mg/dL with simvastatin alone. At 7 years the Kaplan-Meier rate of the primary composite end point was 32.7% with ezetimibe and 34.7% with simvastatin alone (absolute difference 2.0 percentage points; hazard ratio 0.936, 95% CI 0.89 to 0.99; P=0.016). The abstract says muscle, gallbladder and hepatic adverse effects and cancer were similar in the two groups.
Limitations. One randomised trial, double-blind, funded by Merck according to the abstract. The benefit is modest in absolute terms (2.0 percentage points at 7 years). The population was people after an acute coronary syndrome who took simvastatin 40 mg; the result is for adding ezetimibe to that statin, not for ezetimibe alone. Abstract only; the registry record lists Organon and Co as its current lead sponsor.

Record details

Record id: cardio:ezetimibe
Content hash: 3ebc25dddaa588e0a0b4f5eb7df4e71b858427850ebdb5b02086433c2a338065