Cholesterol medication study results
Many clients have asked us to discuss the recently released study results regarding Zetia for cholesterol lowering. While the data just reported in New England Journal of Medicine from this study, the ENHANCE study, is interesting and has turned more attention to the subject, it should not change what a studied and experienced Cardiologist or Family Doctor should be doing. All the evidence supports the first line use of a statin medication to lower LDL cholesterol if diet, exercise and weight loss do not succeed. Zetia (or the combination Vytorin) should have been used if targets were not met or the statin was not tolerated.
The ENHANCE study was a study of artery wall thickness and not targeted to determine other outcome measures. Its participants also had a genetic disorder contributing to their high cholesterol. One can not truly extrapolate the data. We can use it as one of many research and study outcomes to best make a clinical decision for treatment of patients. Cardiovascular disease is still the number one killer in our country and is a complex, multifaceted disease. Even though there was not improved outcome in the artery wall thickness, there was no difference in complications or deaths in the two groups which suggest there is not deleterious consequences to Zetia over the two years if the study.
For now, we recommend evaluating any one who is on Zetia alone to see if they were ever tried on a statin first; if they were not, we would do so. If someone is on both a statin and Zetia, we would see if there was room to increase the statin dose and consider then stopping the Zetia. I would also use this as an opportunity to look at all the other cardiovascular disease risk factors to ensure all efforts are being used to reduce risks (one can enter some of their own risk values at Coronary Heart Disease - Risk Calculator). Modifying life style risks may be the greatest long term benefit.
Please feel free to contact us with questions. If you have not had your cholesterol checked recently, or if you wish to sit down to review all your potential cardiac risk factors, please call to set up an appointment.
Yours in health,