Patient description: The patient is a 57-year-old man with abdominal pain and vomiting. The pain started gradually about 20 hours ago in the epigastric and periumbilical regions, radiating to his back. He drinks around 60 units of alcohol per week and smokes 22 cigarettes per day. He is healthy with no history of allergies or using any medications. His family history is positive for type 2 diabetes (his father and sister). He lives alone and has no children. The abdomen is tender and soft. His bowel sounds are normal. His heart rate is 115/min and blood pressure 110/75 mmHg. The lab results are remarkable for leukocytosis (19.5), urea of 8.5, high CRP (145), high amylase (1200) and Glc level of 15. Cross-sectional imaging was negative for obstructive pancreatitis.

Clinical trial eligibility criteria: eligible ages (years): 18.0-79.0,  Metabolic Syndrome Patient has a diagnosis of metabolic syndrome according to the modified 2005 AHA/NHLBI Scientific Statement with at least Abdominal obesity defined as: *Males: waist circumference >102cm Females: waist circumference >88cm and two of the following 4 other Triglycerides>150 mg/dL HDL Cholesterol Males: HDL-C<40 mg/dL Females:HDL-C<50 mg/dL Blood pressure Systolic Blood Pressure ≥130 mmHg or Diastolic Blood Pressure ≥85 mmHg  Patient has a BMI > 35. 2. Patient has hypersensitivity or intolerance to ezetimibe or simvastatin or any component of these medications, or to latex. 3. Patient routinely consumes more than 14 alcoholic drinks per week. 4. Patient is currently participating or has participated in a study with an investigational compound or device within 30 days of signing informed consent. 5. Patient has a smoking history > 10 pack-years (1 pack-year = at least 20 cigarettes per day for a year) OR patient who has smoked within 3 months prior to Visit 1 (Week -2). 6. Patient has exclusionary laboratory values at Visit 1 (Week -2) as listed in the table below: liver transaminases (alanine aminotransferase [ALT] and aspartate aminotransferase [AST]) > 1.5 X ULN with no active liver disease Serum glucose > 7.0 mmol/L Creatine kinase(CK)> 2 X ULN Albumin:creatinine ratio > 34 TSH <0.3 mcIU/mL or > 5.0 mcIU/mL 7. Patient has a history or current evidence of any condition, therapy, lab abnormality or other circumstance that might confound the results of the study, or interfere with the patient's participation for the full duration of the study, such that it is not in the best interest of the patient to participate. 8. It is not possible to obtain a FMD measurement of sufficient quality at screening (Visit 1) 9. Patient has congestive heart failure, atherosclerotic vascular disease or acute or chronic coronary heart disease. 13. Patient has had a partial ileal bypass, gastric bypass, gastric banding, celiac disease or other significant intestinal malabsorption. 15. Patient has untreated and uncontrolled hypertension with systolic blood pressure >160 mm Hg or diastolic >100 mm Hg at Visit 1 (Week -2). (Patients with untreated hypertension and with office BP at Visit 1 and Visit 2 averaging 160/100 or less can be enrolled). Patients using blood pressure-lowering medication are excluded. 16. Patient has estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m2 based on the 4-variable MDRD 17. Patient has uncontrolled endocrine or metabolic disease known to influence serum lipids or lipoproteins at Visit 1 (Week -2). 18. Patient has diabetes mellitus defined as a history of diabetes or fasting serum glucose > 126 mg/dL. For the full  please check the protocol