Is it time to change from Vytorin?

In today's paper there was a front page article concerning the failure of Vytorin to decrease the risk of heart attack, even though it has been proved to lower LDL, Tri's and artery inflammation. I have read the Enhance study and understand that some of the medical community feel it was flawed as it used 720 individuals as a control group that had a genetic condition that had them predisposed to a very high total cholesterol number to begin with, and that they average a TC of 318 if I remember correctly. There was concern that this was not a proper control group for this type of study. Until now there has not been a movement to change current treatment but the article today said that the American College of Cardiologists is reccommending going back to the old statins for treatment.

I have been on Vytorin for about 7 months and it has worked very well for me. Before that, I had been on Zocor and had similar results and then we went to Tricor because my tri's never seem to change from about 275 - 300 . On Tricor alone I went up to a TC of 211, LDL of 98 and HDL of 38, can't remember my tri's but they did not come down much. My numbers are down considerably on Vytorin to a TC of 151, LDL of 58 and HDL of 40. We recently added Tricor back to my treatment to get a better number on my tri's which still run too high. My question is this, is it time to request a change back to Zocor alone and keep the Tricor for my tri's?

I would be very interested in your opinion.

Thanks,

Jon

[Cleveland Clinic]

I don't think so.  remember that this was a small US trial that looked to CIMT progression in patients with familial cholesterolemia.  The trial did not show a difference in progression between zocor and vytorin, meaning that the two probably have a similar effect on CIMT progression.  As you mentioned earlier, the first problem with the study is the population studied.  The second, the fact that they authors used a surrogate outcome (CIMT) which even though has been linked with CAD or MI, does not stand for CAD or MI.  Larger studies with hard end-point such as heart attack and mortality are needed to say anything definitive.  At this point, if I were you, I would continue with Vytorin unless your cardiologist feels strongly about stopping it.  It really is a matter of opinion, not evidence, at this point.  I really don't think that this study has added or subtracted anything to our understanding of treating CAD.