http://www.kevinmd.com/blog/2009/11/zetia-niacin-affect-carotid-intimamedia-thickness-cimt.html Wed, 15 Feb 2012 00:27:00 +0000 hourly 1 http://www.kevinmd.com/blog/2009/11/zetia-niacin-affect-carotid-intimamedia-thickness-cimt.html#comment-119797 Dr. Matthew Mintz Mon, 23 Nov 2009 01:35:28 +0000 http://www.kevinmd.com/blog/?p=41354#comment-119797 Though both CIMT and biomarkers are surrogate endpoints, I think there is a degree of difference. Biomarkers like LDL and HDL are only what is happening in the blood. CIMT is a measurement of the actual disease process that leads to events. The Zetia studies (ENHANCE and ARBITER) are examples of where the biomarker (LDL) does not have the effect on the disease process (CIMT) that one might think, leading to further evidence that all surrogate endpoints are not equal. It shold be noted also, that in the ARBITER study there actually was a statistically significant diffence in events, though the study was too small to make a definitive conclusion. There are a few incorrect statements by physicians quoted in this report as well. TZD's actually have shown to not only improve CIMT, but also decrease events (PROACTIVE), and the RECORD trial proved that the TZD's did not increase events. Similarly, Crestor has shown to provent progression of atherosclerosis and comes close to showing regression. Thus, though we don't have definitive proof that raising HDL improves outcomes (like we have with lowering LDL with statins), there is mounting evidence and little contradictory evidence. The bottom line is that there is really no good reason to ever use Vytorin, and the value of Zetia might even be questioned. More research is needed into whether raising HDL and lowering triglycerides for patients with low LDL's on statins is of value, and if so, which drug is the best. Though both CIMT and biomarkers are surrogate endpoints, I think there is a degree of difference. Biomarkers like LDL and HDL are only what is happening in the blood. CIMT is a measurement of the actual disease process that leads to events. The Zetia studies (ENHANCE and ARBITER) are examples of where the biomarker (LDL) does not have the effect on the disease process (CIMT) that one might think, leading to further evidence that all surrogate endpoints are not equal. It shold be noted also, that in the ARBITER study there actually was a statistically significant diffence in events, though the study was too small to make a definitive conclusion.
There are a few incorrect statements by physicians quoted in this report as well. TZD’s actually have shown to not only improve CIMT, but also decrease events (PROACTIVE), and the RECORD trial proved that the TZD’s did not increase events. Similarly, Crestor has shown to provent progression of atherosclerosis and comes close to showing regression. Thus, though we don’t have definitive proof that raising HDL improves outcomes (like we have with lowering LDL with statins), there is mounting evidence and little contradictory evidence.
The bottom line is that there is really no good reason to ever use Vytorin, and the value of Zetia might even be questioned. More research is needed into whether raising HDL and lowering triglycerides for patients with low LDL’s on statins is of value, and if so, which drug is the best.

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