Ezetimibe reduces α-tocopherol levels in type 2 diabetes

A. Toffalini, N. Vigolo, N. Rolli, E. Paviati, M. Gelati, E. Danese, G. Zoppini

Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy. giacomo.zoppini@univr.it

OBJECTIVE: α-tocopherol has a protective role against free radical-induced damage. The intestinal absorption of α-tocopherol is in part carried out by Nieman-Pick1-like1 protein, which is the target of ezetimibe, a drug used for the treatment of hypercholesterolemia. Ezetimibe is frequently prescribed to patients with type 2 diabetes in combination with statins. Therefore, the aim of the present study was to investigate the impact of ezetimibe treatment on the blood level of α-tocopherol.

MATERIALS AND METHODS: Two hundred patients affected by type 2 diabetes, regularly attending the diabetes clinic, were recruited. All patients should not have received vitamin supplements in the six months preceding the study. α-tocopherol was measured by reverse-phase high-performance liquid chromatography with UV detection. Other laboratory parameters were determined by standard laboratory procedures. Patients were analyzed according to ezetimibe treatment. A linear multivariate regression analysis was used to estimate the factors associated with α-tocopherol level.

RESULTS: The majority of patients were on ezetimibe/statin treatment. Patients taking ezetimibe showed a significantly lower α-tocopherol level, 29.9±5.7 vs. 32.9±7.0 μmol/L (p=0.006) compared to those not taking the drug. Ezetimibe was significantly and negatively associated with α-tocopherol level in the multivariate analysis (β standardized coefficient = -.217, p = .002).

CONCLUSIONS: Treatment with ezetimibe can reduce α-tocopherol plasma levels by inhibiting the Niemann-Pick C1-like protein. Future studies are required to address the clinical implications of this finding.

Graphical Abstract