Zetia

Many of our patients take “statin” drugs, which have been clearly proven in many studies to reduce the risk of heart attack and stroke. In some patients, we have added Zetia as a “booster” to help them reach the recommended levels. (See also Vytorin)

In 2008, the New York Times reported that in the “ENHANCE” Study, Zetia does not seem to have the cardioprotective benefits previously thought.

See:  http://www.nytimes.com/2008/01/14/business/14cnd-drug.html?_r=1&oref=slogin

(If this link no longer works, just Google “Zetia ineffective”)

You may now be wondering how you should respond to this new development, and we offer you the following thoughts:

• The ENHANCE Study was conducted on patients with a relatively rare inherited condition that causes them to develop extremely high blood levels of LDL cholesterol.  In this population, adding Zetia to Zocor (i.e. Vytorin) seemed to do no better than Zocor alone.
• We know that Lipitor and Zocor are safe and effective.  You should not discontinue these medications unless you discuss it with us first.
• There is overwhelming evidence that the lower the cholesterol, the better.  It is clear that if cholesterol levels are above goal, the risk of heart attack and stroke is increased. The ENHANCE Study was not designed to measure long-term outomes, so that important information is not yet available.

It is our responsibility as your physicians to follow such evolving medical issues for you. You can rest assured that if we decide a change in your medication is needed, you will be contacted at once.

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Click to see the statement from the American College of Cardiology which stresses that “Zetia remains a reasonable option for patients who are currently on a high dose statin but have not reached their goal.”

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Please don’t be caught up in media hype.  The sky is not falling. The only important point to understand is that Zetia (and only Zetia) does not seem to improve removal of cholesterol from artery linings any better than can be achieved with Zocor alone (and only in that special ENHANCE group of patients with severe inherited cholesterol disease).

What is now being debated is whether the additional cholesterol lowering produced by Zetia is of any benefit.  Perhaps it’s not, but for now we still believe that lower cholesterol is better.  Time (and more studies) will tell.

If you’re considering stopping Zetia, please don’t stop it until we’ve discussed it.  If you wish, we can check your cholesterol, stop the Zetia, then recheck cholesterol again after six weeks to test efficacy.