There has been some controversy surrounding the combination cholesterol medication.
Vytorin, a combination of simvastatin and ezetimibe, was found to lower LDL cholesterol, but did not measurably decrease atherosclerotic plaque. Despite this, MedPage Today reports that the FDA recommended that those already on the medication may continue taking it.
As always, internist Matthew Mintz provides further insightful analysis of the situation. The question that the FDA brings up is whether LDL cholesterol is still a reliable surrogate marker for cardiovascular disease. Although the answer seems to be yes, Dr. Mintz warns that “we have been burned by surrogates before. High levels of homocysteine are linked to heart attacks, and folic acid lowers homocysteine, but when we looked at whether folic acid reduced heart attacks (outcomes), it actually caused MORE heart attacks, and is no longer recommended.”
The better question is whether Vytorin should be considered for initial therapy, and I would say that the data argues against this. In light of the recent JUPITER study that associates Crestor with a C-reactive protein-related decrease in cardiovascular events, are you “denying yourself the maximum amount of statin that you need to achieve outcomes” by using the relatively weaker statin contained in Vytorin?
So although Vytorin can be continued safely, whether it should be started in the first place remains very much in question.
