Which lipid-lowering agent is least effective as a first-line treatment for elevated cholesterol?

Ezetimibe is primarily utilized as an adjunctive therapy in the management of elevated cholesterol levels. It works by inhibiting the absorption of cholesterol in the small intestine, thus lowering overall LDL cholesterol levels. However, its efficacy as a sole first-line agent is not comparable to that of statins, which are the cornerstone of cholesterol-lowering therapy due to their proven efficacy in reducing cardiovascular events and their ability to significantly lower LDL cholesterol levels.

When assessing first-line treatment options for elevated cholesterol, statins are widely recognized for their robust clinical trial data supporting their use in cardiovascular risk reduction. Although bempedoic acid has emerged as an alternative option, its role is typically complementary rather than first-line, similar to that of ezetimibe.

In the context of niacin, while it can be effective in increasing HDL cholesterol, its role as a first-line treatment for overall cholesterol management has diminished due to safety concerns and the lack of significant cardiovascular outcome benefits compared to statins. Nonetheless, niacin is not typically recommended as a first-line option.

Considering these aspects, ezetimibe is understood to be the least effective first-line treatment agent for elevated cholesterol when compared to the more potent and established options like statins.