Therapy
Ezetimibe modestly lowers Lp(a) by 7.06%, with no clear clinical relevance, a meta-analysis of 7 trials and 2337 patients (Drugs 2018)
Original title: Effect of Ezetimibe Monotherapy on Plasma Lipoprotein(a) Concentrations in Patients with Primary Hypercholesterolemia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
This systematic review and meta-analysis pooled 7 randomised controlled trials comprising 2337 patients to assess ezetimibe's effect on plasma Lp(a) in primary hypercholesterolaemia, an effect not well defined despite ezetimibe's known ability to lower LDL cholesterol by up to 20%. Ezetimibe 10 mg significantly reduced Lp(a) by 7.06% (95% CI -11.95 to -2.18, P=0.005) compared with placebo, with no significant heterogeneity, though excluding one study made the difference non-significant (P=0.2). Meta-regression found no significant association between Lp(a) change and either LDL cholesterol change (P=0.06) or baseline Lp(a) (P=0.46). The authors conclude ezetimibe monotherapy produces a small but statistically significant 7.06% Lp(a) reduction that, based on current literature, appears to have no clinical relevance.
Original abstract
Background And Aims: Ezetimibe reduces plasma low-density lipoprotein cholesterol (LDL-C) levels by up to 20%. However, its effect on plasma lipoprotein(a) [Lp(a)] concentrations in patients with primary hypercholesterolemia has not been defined.
Objective: Therefore, we performed a systematic review and meta-analysis to assess this effect based on the available randomized controlled trials (RCTs).
Methods: We searched the PubMed and SCOPUS databases from inception until 28 February 2017 to identify RCTs that investigated the effect of ezetimibe monotherapy on plasma Lp(a) concentrations in patients with primary hypercholesterolemia. We pooled mean percentage changes in plasma Lp(a) concentrations as a mean difference (MD) with a 95% confidence interval (CI).
Results: Seven RCTs with 2337 patients met the selection criteria and were included in the analysis. Overall pooled analysis suggested that ezetimibe 10 mg significantly reduced plasma Lp(a) concentrations in patients with primary hypercholesterolemia by - 7.06% (95% CI - 11.95 to - 2.18; p = 0.005) compared with placebo. No significant heterogeneity was observed (χ2 = 5.34; p = 0.5). Excluding one study from the analysis resulted in insignificant differences between the two groups (p = 0.2). Meta-regression did not find a significant association between the mean percentage changes in Lp(a) and other potential moderator variables, which included the mean percentage changes of LDL-C concentrations (p = 0.06) and baseline Lp(a) mean values (p = 0.46).
Conclusions: Ezetimibe monotherapy (10 mg/day) showed a small (7.06%) but statistically significant reduction in the plasma levels of Lp(a) in patients with primary hypercholesterolemia. According to current literature, this magnitude of reduction seems to have no clinical relevance. However, further studies are warranted to clarify the mechanism mediating this effect of ezetimibe and to investigate its efficacy in combination with other drugs that have shown promise in lowering Lp(a) levels.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.