Monday, January 28, 2008

The Zetia Scandal

Schering-Plough, the company that makes Zetia and Vytorin (simvastatin combined with Zetia), released the results of the ENHANCE trial. The trial looked at simvastatin 80 mg versus simvastatin 80 mg plus Zetia 10 mg and the effects on carotid intima medial thickening, in other words, the lining of the carotid artery. The addition of Zetia had no beneficial effect.

I think that the intent of Schering-Plough was to demonstrate that not only is Zetia good at lowering LDL cholesterol, but that it also has a beneficial effect on the lining of the arteries, and therefore can protect against cardiovascular events. Clearly, the study fell short.

I've gotten phone calls and e-mails from patients on Zetia asking, should I stop taking Zetia? Does it matter if my cholesterol is lowered?

The bottom line is this: There is great data for statins, particularly simvastatin (Zocor) and atorvastatin (Lipitor) for lowering cholesterol and reducing event rates. With these medications, we know that lower cholesterol is better, with an optimal LDL goal of 60-70. And, I think that this new study lends credibility to the theory that it does matter what class of drugs are used to lower cholesterol, that it's not just the cholesterol lowering effect of the statins that make them so effective, it's also the effect on the arteries' lining.

However, some people cannot tolerate statin medications due to muscle aches or liver function problems. For these patients, Zetia might be an appropriate alternative.

If you're taking Zetia or Vytorin, please do not stop your medicine. Talk to your doctor. If you are on Zetia alone, you may ask if you should be on a statin instead. There may be good reason why you are on Zetia.

4 comments:

Sarah C. said...

I have a cholesterol question that perhaps you can shed light on. A long-time vegetarian, I had my cholesterol checked a few years ago and it was 253, but my HDL was extremely high and my LDL extremely low and my triglycerides extremely low. My naturopathic doctor and I talked about retesting my cholesterol now (having gone mostly vegan and upped my exercise), but we haven't done it yet. Then I start to read that perhaps the numbers don't have as much to do with heart disease as we had thought, and now I'm confused. Should someone like me be worried about numbers?

VeganHeartDoc said...

It sounds like your numbers before were very good. HDL is protective against heart disease. In anyone, cholesterol should be checked at least every five years.

Numbers still matter -- low HDL and high LDL cholesterol increase risk of heart disease.

SallyT said...

Have you listened to Fitness Rocks? It's a podcast done by an anaesthesiologist who reviews medical literature related to fitness and health. It's a good listen and he has a lot to say about statin drugs. You might enjoy it!

wingraclaire said...

Thanks for the interesting information. I have been taking simvastatin for six weeks, after trying other solutions. I think it's just in my genetic makeup to have high cholesterol, but I take it seriously. And I enjoy your blog!