Successful Treatment of Statin Resistant Hypercholesterolemia by an Inhibitor of Cholesterol Absorption, Ezetimibe

Abstract

HMG-CoA reductase inhibitors (statins) are frequently prescribed against hypercholesterolemia, and these agents successfully suppress levels of serum LDL-cholesterol in most cases. We experienced a case of hypercholesterolemia resistant to statins, but well responsive to an inhibitor of cholesterol absorption in the intestine, ezetimibe. The case was a 58-year-old, non-obese female with persistent high-levels of LDL-cholesterol (LDL-Cho) around 200 (193 - 204) mg/dl even after administration of statins, pitavastatin or rosuvastatin. An inhibitor of cholesterol absorption, ezetimibe was added to rosuvastatin, which resulted in lowering serum LDL-Cho levels to 90 mg/dl. The actual reduction rate of LDL-Cho was 5.4% by rosuvastatin alone, and this rate was up to 53.4% by adding ezetimibe. These results suggest that enhanced cholesterol absorption, rather than cholesterol synthesis, caused hypercholesterolemia in this case. Cholesterol absorption is accelerated in some diseases or conditions, such as diabetes mellitus and obesity, both of which were not identified in this case. Unknown genetic or acquired abnormalities in the intestinal cholesterol-transporting system may be involved in developing hypercholesterolemia. Hence, suppression of cholesterol absorption is a considerable option for hypercholesterolemia resistant to statins.




J Med Cases. 2011;2(2):44-47
doi: https://doi.org/10.4021/jmc124w