Hypercholesterolemia is a major risk factor for cardiovascular diseases that has been managed mostly with 3-hydroxy-3-methyl glutaryl coenzyme A reductase inhibitors (statins) that suppress de novo cholesterol synthesis in the liver. Statins also have beneficial pleiotropic effects on the atherosclerotic process that are independent of their ability to lower lipid values. However, the levels of low-density lipoprotein cholesterol (LDL-C) in most hypercholesterolemic patients at high risk for cardiovascular disease do not reach the goals proposed by guidelines even when prescribed with statins. Ezetimibe is a new lipid-lowering agent that blocks the intestinal absorption of dietary and biliary cholesterol and reduces LDL-C levels, especially when combined with statins. However, its effect on cardiovascular events remains unknown. We reviewed the effects of ezetimibe on cardiovascular diseases, in particular, vascular endothelial function, which is initially impaired during the atherogenetic process and an important predictor of cardiovascular events. Increasing evidence suggests that ezetimibe improves endothelial function and nitric oxide availability, and reduces inflammation as well as oxidative stress. However, this mechanism has not been clarified and limited, large trials and cohort studies have not shown that this agent prevents cardiovascular events. Ezetimibe has just recently become commercially available, which might explain the paucity of evidence regarding its benefits and effects on cardiovascular morbidity and mortality.