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Don't quit cholesterol drug Zetia or related Vytorin without your doctor's permission.
By CHANDRA BROADWATER, Times Staff Writer
Published January 16, 2008
ST. PETERSBURG - Confused patients kept the phone lines busy Tuesday at the offices of local cardiologists.
Should I stop taking Vytorin? What about Zetia?
The confusion stems from the results of a long-awaited study that found that the widely popular Zetia, a cholesterol-lowering drug, failed to reduce the growth of artery-clogging plaque as thought. Simply put, the drug that is prescribed to about 1-million people a week doesn't work.
While the study brings into question the use of Zetia alone, it also raises concerns over the use of Vytorin, which combines Zetia with the statin Zocor.
What should patients do? Dr. Peter Wassmer, cardiologist and chief of staff at the Tampa Bay Heart Institute at Northside Hospital, urges people not to panic:
What are you hearing from patients?
Basically, whether they should stop taking the drugs or not. The answer is no. Continue taking your medications as prescribed and talk to your doctor.
Should patients taking Zetia be concerned?
It was thought that because Zetia lowers cholesterol, that it could be used as a stand-alone for patients with heart disease. The idea was that since it lowers cholesterol levels, then it could have a possible impact on the prevention of heart disease.
Unfortunately, A plus B does not equal C. Patients who are taking Zetia alone, with the idea that it will prevent future coronary events, might need to be on a statin. They should ask their doctors.
What is the difference between how a statin works and how Zetia works?
Statins are drugs that have been shown to stop coronary plaque and decrease the risk for heart attacks. They work by preventing the production of bad cholesterol LDL in the liver and stabilize the plaque or cholesterol that deposits in the heart vessels. Most heart attacks are caused by plaque ruptures that block the vessels, and statins make it less prone to ruptures.
While Zetia does lower cholesterol levels by preventing the absorption of cholesterol in the stomach, this study shows that it does not stabilize plaque like statins do. It appears that by itself, it does not lower future risks of coronary events.
What about those who are taking Vytorin?
The Zocor portion of Vytorin works fine. The Zetia portion is neutral. If a patient's lipid and cholesterol levels look fine, then I would leave them on it. But everyone's different. Some people can't handle higher doses of statins and complain of muscle aches and other side effects. That's one of the reasons why the Vytorin combination was promoted the way it was. They thought that it might be possible to get away with lower doses of Zocor. Again, talk to your doctor.
Does Zetia increase the risk of coronary disease?
No, the study did not show that there are any other side effects caused by its use. It just essentially shows that when it comes to preventing heart disease, it's a placebo. It's not harmful and does have benefits such as reducing cholesterol. This is nothing like the Vioxx deal, where people died.
Do you have any other suggestions for concerned patients?
Just make sure to call your physician and ask them any questions you might have. And the last thing anyone should do is stop taking medications.
Information from the New York Times was used in this report. Chandra Broadwater can be reached at firstname.lastname@example.org or (352) 848-1432.
About the study
A clinical trial of Zetia, a cholesterol-lowering drug used in combination with Zocor to create the drug Vytorin, failed to show that the drug reduces growth of fatty plaque in arteries that can cause heart problems, according to Merck and Schering-Plough Pharmaceuticals.
The trial, called Enhance, covered 720 European patients with a gene that causes them to produce very high levels of low-density lipoprotein, called LDL, or bad cholesterol. Patients in the trial had LDL levels that were three times the level cardiologists recommend.
Completed in 2006, the two-year study showed that patients who took Zocor alone reduced their LDL by 41 percent on average. Patients who took Vytorin reduced their cholesterol by 58 percent.
Yet despite the larger cholesterol reduction, patients taking Vytorin had more fatty plaque growth in their carotid arteries than those on Zocor.
[Last modified January 16, 2008, 01:11:51]