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Cholesterol Drug Change May Be Risky

Study by Maker of Statin Drug Lipitor Raises Questions About Switching to Generic Versions
By
WebMD Health News
Reviewed by Louise Chang, MD

Lipitor Switch Risky

Sept. 5, 2007 -- Patients who switch from the statin drug Lipitor to a generic version of another statin may be more likely to suffer strokes, heart attacks, and death, a new study from Lipitor manufacturer Pfizer shows.

Researchers for the drug maker reported a 30% increase in risk for major cardiac events or deaths from all causes among patients who switched from Lipitor to simvastatin, the generic version of Merck & Co's cholesterol-lowering drug Zocor.

The generic statin was approved for sale in the U.S. in June 2006. It has been available in the U.K. since 2003.

Pfizer researchers compared outcomes among patients taking Lipitor who were and were not switched to simvastatin.

They say the findings highlight the potential for increased risk when patients are switched from one statin to another.

But all agree that they don't prove Lipitor is better or safer than a different cheaper, generic statin.

"We can't say from this study that switching is bad or that one statin is better than another. You would need a randomized, clinical trial to say that," cardiologist Berkeley Phillips, MD, of Pfizer tells WebMD.

"But there has been a lot of switching in the U.K. and across Europe, and this does raise concerns about policies that advocate widespread switching for purely economic reasons with little thought to a patient's individual risk," he says.

Switching Statins

Using anonymous patient records from a medical database in the U.K., Phillips and colleagues compared cardiac outcomes and deaths from all causes among 2,511 patients who took Lipitor for at least six months and were then switched to generic simvastatin with just over 9,000 patients who remained on Lipitor.

The patients in the two treatment groups were matched for age and certain cardiovascular risk factors. But it was not known why patients switched medications or how many deaths were due to cardiovascular causes.

Compared with the patients who remained on Lipitor, those who switched to simvastatin were 43% more likely to suffer from a major cardiovascular event such as heart attack or stroke. They were twice as likely to suffer strokes, and 36% more likely to have heart attacks, although the data for heart attack risk was not statistically significant.

Patients who switched were also twice as likely to stop taking their medication against doctors' orders.

The findings were presented in a poster session in Zurich Wednesday during the final day of the annual European Society of Cardiology Congress.

More Questions Than Answers

Cardiologist Robert Bonow, MD, tells WebMD that the study raises more questions than it answers.

Bonow is chief of cardiology at Chicago's Northwestern Memorial Hospital and a past-president of the American Heart Association.

He points out that the differences among the two treatment groups could help explain the different outcomes.

As a group, the patients who remained on Lipitor also took more heart medications and had better cholesterol control to begin with than the patients who switched to simvastatin.

He says for patients who achieve good cholesterol control with low doses of statins, switching to a generic is probably OK.

"Switching just because a drug is cheaper is not the right thing to do," he says. "Many patients will do fine on the generic drug, but patients have to be followed carefully to make sure they achieve the [cholesterol] control you are aiming for. You can't just switch them and say, 'See you next year.'"

A spokesman for simvastatin and Zocor manufacturer Merck & Co. declined comment on the study Wednesday, saying company officials had not had a chance to review the data.

"The safety and efficacy of Zocor has been well documented for more than 15 years," Ian McConnell told WebMD.

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Your total cholesterol level is in the Desirable range, but your level of "bad" LDL cholesterol is High. This may mean that your level of high-density lipoprotein (HDL), or "good" cholesterol, is too low. It is best to have a high level of "good" HDL and a low level of "bad" LDL. The HDL helps keep your LDL level in check. Ask your doctor for your HDL level. If your HDL is low, increasing your physical activity can increase it, which may help reduce your LDL level.

Your total cholesterol level is in the Desirable range, but your level of "bad" LDL cholesterol is Very High. This may mean that your level of high-density lipoprotein (HDL), or "good" cholesterol, is too low. It is best to have a high level of "good" HDL and a low level of "bad" LDL because the HDL helps keep your LDL level in check. Ask your doctor for your HDL level. If your HDL is low, increasing your physical activity can increase it, which may help reduce your LDL level.

Your total cholesterol level is Borderline High, but fortunately your level of "bad" LDL cholesterol is optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have other non-measured increases in LDL-like particles that can increase heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol level is Borderline High, but fortunately your level of "bad" LDL cholesterol is near optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have other non-measured increases in LDL-like particles that can increase heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol level is Borderline High. Your level of "bad" LDL cholesterol is Borderline High, too. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol level is Borderline High. Your level of "bad" LDL cholesterol is High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol level is Borderline High. But your level of "bad" LDL cholesterol is Very High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol is High, but your level of "bad" LDL cholesterol is optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have elevated secondary lipids, such as non-HDL particles that increase the risk of heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol is High, but your level of "bad" LDL cholesterol is near optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have elevated secondary lipids, such as non-HDL particles that increase the risk of heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol level is High. Your level of "bad" LDL cholesterol is Borderline High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol level is High. Your level of "bad" LDL cholesterol is High, too. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels! If you are struggling to bring down your total cholesterol and LDL cholesterol levels, your doctor may prescribe medication, such as statins. Following medication, dietary, and exercise instructions should result in improvements.

Your total cholesterol level is High, and your level of "bad" LDL cholesterol is Very High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels! If you are struggling to bring down your total cholesterol and LDL cholesterol levels, your doctor may prescribe statins or other cholesterol-lowering medications.

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