Distinction between good synthesizer and good absorber patients to optimize cholesterol-lowering therapy

The inhibition of cholesterol synthesis by a statin enhances intestinal absorption of both cholesterol and various phytosterols. The atherogenic role of phytosterols, well proven in hypersitosterolemia, is now suspected in patients with premature coronary artery disease. The cholestanol/cholesterol ratio can be used as a marker of intestinal cholesterol absorption. Individuals with elevated ratio ("high absorbers") have less favourable cholesterol-lowering response and cardiovascular protection with statin therapy as compared to individuals with low ratio ("high synthesizers"). They may benefit of an adjunct therapy with phytostanols or ezetimibe, both being capable to reduce plasma concentrations of cholesterol and of phytosterols