Vytorin study

[Flycaster305]

My question covers a very big topic regarding the cholesterol drugs that are meant to control high ldl cholesterol counts caused by both diet and hereditary.  In my specific case, I take Vytorin 10/40, and since taking this drug my cholesterol numbers are, in my doctor's words, 'perfect'... ldl below 75, hdl above 50, tri's are excellent.  I also control my cholesterol with diet and exercise, and formerly I had extremely high cholesterol and poor ratios.    However, I continue to have problems with CAD, I'm averaging a stent every four months.  All this confuses me greatly.  Can you enlighten me a bit regarding this study?  Are you encouraging your patients to take a different statin drug?

Thank you for this forum.

[Cleveland Clinic]

The trial I assume you are reporting shows no evidence of recession and in fact progression of CAD on patients who  were on Vytorin. Of the two components of vytorin, simvastatin has clearly been shown to decrease the rate of death, myocardial infarction and stroke, in over 40,000 patients. It is probably the best studied statin, and I have no problems prescribing it. Ezetimibe has been shown to decrease LDL cholesterol, but there is no life saving data in the published literature. So it depends if you think that LDL lowering automatically improves mortality independent of the mechanism or not.
I and most physicians at our institutions prescribe medications which have been shown to improve mortality, because that is the endpoint what we care for, so while we usually do not stop vytorin if patients are already on it, we usually favor starting statins instead.

[erijon]

Great question, looking forward to a reply. I too am on Vytorin 10/40 and my numbers have been great, TC 151, LDL51, HDL 40 but my tri's are still high so they added Tricor, we'll see how that works. Fortunatley, I have not had any signs of CAD in my 49 years and three cardiac workups the past three years (all normal with echos, blood work and thallium stress tests) and don't really have any risk factors other than being a male and a little overweight, but I too was concerned about the study that just came out. I also made some lifestyle changes and have been exercising daily for about a year and a half with no problems and have lost 60 pounds, but I don't want the effort wasted if there is an issue with Zetia.

Thanks for asking

Jon