Ezetemibe is an add on. It is best used with a statin and/or Bempedoic Acid. My family and I have had excellent results with Ezetemibe and RCTs have also shown the same.
I’m sorry your results didn’t turn out as well as the RCTs, but we all have different reactions to different medications.
Right. I was hoping ezetimibe as add on to the pitavastatin would be a win, but it completely wrecked my lipid profile. Since 08/09/25 I’ve been on Brillo EZ, 180mg/day bempedoic acid and 10mg/day ezetimibe in addition to the pitavastatin 4mg/day. October 28, I will have my next test, so curious to see what happens. I’m not optimistic. My options are shrinking. I may have to start thinking about a PCSK9i, while waiting for some drug to crush my also sky high Lp(a). What a mess.
And all of this on a diet optimized to eliminate as far as possible saturated fat, EPIC amounts of fiber, including multiple kinds of soluble fiber, psyllium etc., pescetarian etc. good exercise, low stress etc.
Yes, we all have our individual biological makeups, and mine is trying to kill me by atherosclerosis (fortunately, CAC score zero at 65yo).
I can only envy people’s good lipid profiles and responsiveness to meds. Luck of the draw, I pulled a joker from the lipid panel deck. 
I don’t see any other option than testing a PCSK9 inhibitor if you want to decrease that apoB further. I would do one 150 mg Praluent pen x1 month (Q4W) to start with and see how apoB is at the end of the month after dosing and some time after.
I couldn’t find it anywhere though.
“The surge in demand has led to limited availability in China, and some other countries,” Sanofi said in a statement, adding that “at the moment Praluent’s supply in China has already stopped.”
Or if PCSK9 inhibitors aren’t available there’s less evidence but a 6-month siRNA PCSK9i like inclisiran.
Yes, I’ll look into a PCSK9i, early next year, still some tweaking in the meanwhile.
Technically you could go on a high intensity statin like all of the Ivy League doctors love to put people on (compared to humble NJ doctor Dayspring with his low dose statin + ezetimibe combo). Then add on top of that ezetimibe and maybe bempedoic acid afterwards.
Combine with oat beta glucans supplement and maybe portfolio diet, check OGTT test (insulin resistance), Boston cholesterol balance test if you’re overabsorber or oversynthesizer, probably the latter.
Lots of unsolicited advice but it’s a discussion forum after all.
Hey, advice always welcome! I already do beta glucan, for possble IR I’ll be trialling low dose pioglitazone early next year, so still some tweaking to do.
HIS, pitavastatin is only dosed at moderate intensity (4mg), so it would mean switching to something like rosuvastatin at the highest dose, maybe atorvastatin 80mg. I’m not anxious to switch, as I like the pitavastatin profile, not raising Lp(a), which is already sky high for me, no blood sugar raisng (I’m prediabetic A1c 5.7), and in general you don’t gain proportionally as much going up in dosage from statins. It’s an option in a pinch, I guess. I might think about going off label with 8mg pitavastatin, there were some studies in Asia at that dosage, good tolerance, but that’s starting to push my risk tolerance.
I guess PCSK9i is the most likely. We’ll see.
I think it was like 4-5 pp reduction in LDL-C/apoB for every doubling of the dose, so it could be a 10% reduction. If that pushed up your absorption it would be synergistic with ezetimibe, maybe that’ll be the case with your fourth test with adding in bempedoic acid.
I’d avoid 8 mg pitavastatin as well and yeah prediabetes seem difficult. Obicetrapib, you’re our only hope (effects + cost + availability + oral).