Effect of ezetimibe on cholesterol absorption and lipoprotein composition in diabetes and metabolic syndrome

Ezetimibe exerts multiple favorable effects on the lipoprotein profile and reduces some inflammatory markers. Decreasing cholesterol synthesis with statin treatment can cause a compensatory increase in cholesterol absorption that reduces the efficacy of statin therapy, whereas addition of a cholesterol absorption inhibitor can improve outcomes. Recent evidence suggests a beneficial effect on atherosclerosis. In patients with diabetes, the effect of insulin resistance on low-density lipoprotein metabolism combined with the effect of hyperglycemia on cholesterol absorption may further diminish the favorable effects of statins. Further analysis is needed also to determine whether the stronger effects of ezetimibe seen in patients with diabetes are a consequence of an interaction of the drug with specific mechanisms.