Patients on Vytorin or Zetia

On 1/14/08, the results of a 2 year, 720 patient trial became available to the public called the ENHANCE trial.  It looked at patients who have a genetic abnormality leading to LDL ("bad cholesterol") of greater than 300. The study looked at measurements of the thickness in the arteries in the neck (CIMT, a test offered in our office) and what effect simvastin had verses simvastatin and Zetia (Vytorin).  This thickness and worsening of the thickness in the artery are signs that might lead to heart attacks and/or strokes.  The study was not designed to see if Vytorin decreased the risk of death, heart attacks or strokes.

The study did show the following:

  1. A signiicant reduction in LDL-C in Vytorin vs simavastatin alone.
  2. No statistical difference in the change of thickness in the carotid artery (CIMT) between the two medications.
  3. No statistical differences in death rates, heart attack, or stroke in the two groups.

So what does all of this mean?

  1. Zetia/Vytorin was not shown to hurt patients.
  2. Zetia is still an option for those patients who cannot take or tolerate statins, as it will lower your LDL-C.  However, we don't know for sure if it will lead to lower risk of heart attacks and strokes.
  3. Zetia/Vytorin may have been used to treat your cholesterol so that we did not have to go to the higher doses of a particular statin.  Higher dosages of statins may have more side effects.  Your specific situation may lead to getting off of Zetia/Vytorin and take a slight risk of a higher dose statin to decrease your risk of a heart attack or stroke.
  4. Three large studies are ongoing but will take about three years to be published to see if Vytorin actually reduces heart attacks.
  5. This study was in a specific high risk population, how this would affect you may be different.

In summary, DON"T PANIC.  We recommend you discuss this matter with your physician at your next appointment while contuning your medication.  Feel free to make an appointment sooner if you wish to discuss this matter.  Be cautious reading all the internet articles as some may not be from recognized medical sources.  We have included a link to the American College of Cardiology for your review.  As always, continue to improve your diet and exercise habits.