Kevin’s Story

I first met Kevin when he was 60. He had a longstanding history of elevated cholesterol levels. Despite multiple efforts to manage his cholesterol through dietary changes and regular exercise, Kevin’s levels remained above the recommended range. He maintained a moderately active lifestyle, including daily walks and occasional cycling, and adhered to a diet focused on whole foods with limited saturated fats. However, these lifestyle adjustments alone proved insufficient for optimal cholesterol control.

Kevin’s family history included cardiovascular disease; his father had suffered a heart attack in his early 60s. Additionally, Kevin had been diagnosed with hypertension, which he managed with antihypertensive medication for the past five years. Aside from this, he had no known history of diabetes or other significant health issues.

Clinical Features

Kevin’s cholesterol profile revealed a total cholesterol level of 280 mg/dL (normal: less than 200 mg/dL), low-density lipoprotein (LDL) at 190 mg/dL (normal: less than 100 mg/dL), high-density lipoprotein (HDL) at 40 mg/dL (optimal: 40–60 mg/dL), and triglycerides at 160 mg/dL (normal: less than 150 mg/dL).

These results indicated significantly elevated total cholesterol and LDL levels, borderline high triglycerides, and HDL levels on the lower end of the ideal range. Kevin did not report any physical symptoms commonly associated with high cholesterol, which is often asymptomatic. However, he expressed concern about his cardiovascular risk, particularly given his father’s history of a heart attack in his early 60s. Kevin’s main worry was the potential for a heart attack or stroke, which motivated him to explore further treatment options.

Initiation of Zetia

I chose Zetia (ezetimibe) for Kevin due to his inability to achieve target cholesterol levels through lifestyle changes alone. Although he had no reported intolerance to statins, his primary care physician had initially prescribed a low-dose statin, which resulted in only modest cholesterol reduction. When it became clear that statin therapy alone was insufficient for optimal LDL lowering, I added Zetia to his treatment plan. Zetia works by inhibiting cholesterol absorption in the small intestine, making it an effective complement to statins by further lowering LDL levels.

I prescribed Zetia at 10 mg once daily, taken orally. The medication is generally well-tolerated and convenient, with its once-daily dosing beneficial for patients who may face challenges adhering to more frequent regimens.

In addition to Zetia, I advised Kevin to continue his low-dose statin, allowing for dual-action cholesterol management: Zetia to reduce cholesterol absorption and the statin to decrease cholesterol production. I instructed him to take both medications consistently, ideally at the same time each day, and to maintain his diet and exercise efforts as part of a comprehensive treatment approach. Regular follow-ups were scheduled to monitor Kevin’s cholesterol levels, liver function, and any potential side effects from the combination therapy.

Zetia For the Win!

Kevin was scheduled for follow-up appointments every three months to evaluate his response to Zetia and monitor for any adverse effects. At each visit, his cholesterol levels were measured, and liver function tests were performed to check for potential hepatic effects from the combined Zetia and low-dose statin therapy. After the first three-month follow-up, Kevin's LDL levels showed a promising decline, though they had not yet reached the target range. To enhance cholesterol reduction, I kept the Zetia dose at 10 mg but slightly increased the statin dosage. Kevin continued this regimen without further changes as his lipid levels began to stabilize.

After six months on Zetia and the adjusted statin therapy, Kevin's cholesterol profile demonstrated significant improvement: total cholesterol reduced from 280 mg/dL to 190 mg/dL, LDL decreased from 190 mg/dL to 95 mg/dL—now within the desired target range—HDL rose slightly from 40 mg/dL to 45 mg/dL, indicating better cardiovascular health, and triglycerides dropped from 160 mg/dL to 130 mg/dL, now within normal limits. These results highlighted substantial progress, with Kevin's LDL levels reaching the target range, moderate improvement in HDL, and normalized triglycerides.

Kevin reported a positive experience with Zetia, experiencing no notable side effects, which contributed to his consistent adherence to the medication. Throughout the treatment, he felt more confident about his cardiovascular health and experienced less anxiety regarding his risk of heart disease. Motivated by his improved cholesterol profile, Kevin made further lifestyle enhancements, incorporating more fiber-rich foods and maintaining his regular exercise routine. These changes contributed to modest weight loss, further supporting his cardiovascular health. The combination of Zetia, statin therapy, and lifestyle adjustments helped Kevin achieve his health goals, fostering a sense of well-being and better control over his long-term health.

If you have a history of high cholesterol, consult with a healthcare provider to explore treatment options tailored to your needs. High cholesterol can significantly increase the risk of serious cardiovascular events, such as heart attacks and strokes, making effective management essential for long-term health. Medications like Zetia can be instrumental in lowering cholesterol levels, particularly when lifestyle changes alone are insufficient. However, all medications have potential benefits and risks. A healthcare provider can guide you on how Zetia works, potential side effects, and its role within a comprehensive cholesterol management strategy. An informed discussion with your provider ensures you understand the benefits and risks of treatment, helping you make the best decision for your health.