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Cholesterol & Triglycerides Health Center

Study Casts Doubts on Vytorin, Zetia

Cholesterol-Lowering Drugs May Not Reduce Plaque Buildup
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WebMD Health News
Reviewed by Louise Chang, MD

Jan. 15, 2008 -- Disappointing results from a long-awaited trial of the best-selling cholesterol drug Vytorin drew mixed reactions from some of the nation's leading cardiologists.

Vytorin, which combines the unique cholesterol drug Zetia with the traditional statin drug simvastatin, was found to be no better than simvastatin alone for reducing plaque buildup in the carotid arteries. The carotid arteries run through both sides of the neck to the brain.

In fact, patients taking Vytorin actually had slightly more plaque buildup during the trial than those taking simvastatin alone.

The findings were revealed Monday morning in a news release issued by the drug companies Merck and Schering-Plough, which jointly market Vytorin and Zetia.

In an interview with WebMD, cardiologist Steven E. Nissen, MD, called the results "a stunning reversal for Zetia and Vytorin."

Nissen is chairman of the department of cardiovascular medicine at the Cleveland Clinic, and is a past president of the American College of Cardiology.

"Zetia works only by blocking the absorption of cholesterol, but it has not been shown to produce any health benefits," he says. "I have been skeptical of these drugs from the beginning because I wasn't sure that Zetia's mechanism of cholesterol lowering would produce the same benefits that we see with statins."

But P.K. Shah, MD, who directs the cardiology department at Cedars-Sinai Medical Center in Los Angeles, tells WebMD that the trial results do not mean that the millions of patients taking Zetia or Vytorin derive no benefit from the drugs.

"I don't think this is a call for a moratorium on Zetia. That would be overreaching," he says. "This was a small study and it is not the last word."

(Do you take Zetia? Will you talk to your doctor now? Tell us about it on WebMD's Cholesterol Support Group board.)

Congressional Probe of Zetia, Vytorin Research

The release of the results came just weeks after the announcement of a congressional investigation into the drug companies' actions surrounding the study, which ended nearly two years ago.

In addition to delays in presenting the results, critics had accused the companies of attempting to change the endpoints of the study, known as the ENHANCE trial, in an effort to present the results in a more favorable light.

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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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