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.
Related posts:
- Why you should stop taking Vytorin for high cholesterol
- Does Avandia cause heart attacks, and why the RECORD study is important
- Vytorin, one of the worst blunders of the year?
- Vytorin continues to take hits
- Vytorin spin
- Vytorin: Stick a fork in it
- Vytorin, the "besmirched drug du jour"
{ 1 comment }
Hi Kevin,
I don’t understand why it matters whether someone is already on Vytorin (simvastatin/ezetimibe) or not. If they are on Vytorin, they are presumably not statin-intolerant and could be switched to a statin. Switching is as easy as writing a prescription and then doing some followup lab work. Given that we know statins work, and we don’t know whether ezetimibe works, why not stick with what we know?
We do not even know that ezetimibe is safe, since in the SEAS trial the group that received ezetimibe had more cancer cases and deaths. Why take a chance?
Best, Marilyn
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