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Vytorin’s Shortcoming a Boon for Statins

Disappointing Results of Vytorin Study Lead Doctors to Call for Return to Proven Cholesterol-Lowering Drugs

Vytorin Still Has Place in Treatment

If all those efforts fail, it's time to try Vytorin, the panel says.

Also, some patients taking statins, particularly at high doses, develop side effects such as muscle weakness and need alternatives, Smith says.

Study researcher Kastelein says that for the people he studied, all of whom had a genetic disposition to high cholesterol, high-dose statins plus Zetia is the only treatment that works.

"So what can I do? I certainly can't [take them off it]," he tells WebMD.

"I don't think we should take patients off it if they are doing well," agrees AHA past president Robert Bonow, MD, of Northwestern University in Chicago.

Why Did Vytorin Fail?

Kastelein says there are three possible reasons why Vytorin failed. One possibility is flaws in the technique used to measure plaque, but that’s "highly unlikely," he says.

Or it could be that the drug just doesn't work, but he says previous studies have shown that LDL is what counts, and it "doesn't matter how you reduced LDL," Kastelein says.

The most likely explanation, he tells WebMD, is that the participants did not have enough plaque buildup at the start of the study -- in other words, they were at too low of a risk to show benefit in a two-year study period.

Michael Davidson, MD, of the University of Chicago, says, "Lower LDL is better, and it doesn't matter how you get there.

"We don't feel Zetia is the reason ENHANCE didn't work. That is a possibility we have to list, but it is far less likely [than the population being too low-risk]," he says.

Krumholz maintains it's the pill. "It could also be that Zetia is just an expensive placebo and that its principal harm is it drains precious resources from our health care system and may lead people to use less of the drugs that we know are effective and beneficial," he says.

The bottom line, of course, is that no one knows for sure.

For now, all the doctors say they are eagerly awaiting the results of three larger ongoing trials, involving more than 20,000 patients, that are designed to show whether Zetia and Vytorin prevent more adverse events and deaths than statins alone.

Researchers said this week that they are expanding enrollment of the largest of those trials, IMPROVE-IT, to 18,000 patients, to ensure there are enough participants to show clear results. Those findings won't be available until about 2012.

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Your total cholesterol level is in the Desirable range, but your level of "bad" LDL cholesterol is borderline high. If your LDL goes higher, your total cholesterol level could become Borderline High. Consider reducing the amount of foods you eat with saturated fats and increasing physical activity. If you get more exercise, your level of "good" HDL cholesterol may increase, which could also help to keep your levels of LDL and total cholesterol in check.

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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