Ézétimibe : plus de preuves pour un effet sur la réduction du risque cardiovasculaire

Ezetimibe is an agent reducing intestinal cholesterol absorption by inhibiting NPC1L1 transporter. This reduction in cholesterol absorption induces, via a decrease in the cholesterol pool in the hepatocytes, an increase in LDL receptor expression leading to enhance LDL-cholesterol (LDLc) catabolism and, as a consequence, to reduce plasma LDLc level. Recently, came out important pieces of evidence for the efficiency of ezetimibe to reduce cardiovascular risk. A large Genome Wide Association Study showed that individuals with inactivating mutations of NPC1L1 had, in parallel with a decreased LDLc plasma level, a significant reduced cardiovascular risk. The PRECISE-IVUS study demonstrated a higher rate of coronary atherosclerotic plaque regression in patients treated with atorvastatin + ezetimibe compared to those treated with atorvastatin alone. In addition, the prospective IMPROVE-IT trial, had shown a significant reduction in major cardiovascular events (P=0.016), in myocardial infarction (P=0.002), in ischemic stroke (P=0.008), in coronary mortality (P=0.02), and in cardiovascular mortality (P=0.04) in patients treated with simvastatin + ezetimibe compared to those treated with simvastatin alone.