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News:

Ezetimibe (Zetia®) Effectiveness Questioned

According to a recent press release by the manufacturers of Zetia® (ezetimibe) and Vytorin® (ezetimibe plus simvastatin), ezetimibe may not help slow the progression of atherosclerosis, which can lead to heart attacks and strokes. The manufacturers discussed the results of the ENHANCE trial, a 2 year study that compared the effects of ezetimibe plus simvastatin with simvastatin alone on carotid artery plaque buildup in patients with very high cholesterol levels. It was hoped that the addition of ezetimibe to simvastatin would slow plaque growth more than simvastatin alone. Instead, plaque buildup was greater with the combination, although the difference was not statistically significant. A congressional investigation is underway to sort out why Merck and Schering-Plough, who co-market Vytorin® and Zetia®, delayed the release of the ENHANCE results. It isn’t clear why the addition of ezetimibe to simvastatin does not reduce plaque buildup, despite a greater decrease in LDL cholesterol levels. Statins alone have been shown to reduce the risk of heart attack; whether ezetimibe has a similar benefit remains unknown.

Concerned patients should be aware that the ENHANCE study was fairly small and did not evaluate the effect of ezetimibe on heart attack or stroke rates. Tell them that further study is needed. Let patients know that expert cardiologists consider ezetimibe a reasonable option for patients on high dose statins who have not reached their LDL goal, and patients who cannot tolerate statins or can only tolerate a low dose.

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