Harvard Heart Letter

Heart Beat: Uncertainty dogs Zetia and Vytorin

Heart Beat

Uncertainty dogs Zetia and Vytorin

It's been a confusing time for the millions of people who take ezetimibe, a cholesterol-lowering drug. Ezetimibe is sold alone as Zetia and with simvastatin (Zocor) as Vytorin. In January 2008, results from a small trial showed that Vytorin didn't reduce artery-clogging plaque any better than simvastatin alone. In July 2008, preliminary results from a larger trial showed that taking Zetia with a statin didn't slow the narrowing of heart valves any better than the statin alone. But it did seem to be linked to an uptick in cancer. To check that unexpected and worrisome finding, Oxford University researchers looked at cancer cases in two ongoing trials of Vytorin that include more than 20,000 volunteers. The results, published online in The New England Journal of Medicine, were reassuring but didn't completely close the door on a Zetia-cancer link.

Zetia works by preventing cholesterol in food from crossing the intestinal wall and getting into the bloodstream. In theory, it's a good addition to a statin, which lowers cholesterol a different way. Taking Zetia and a statin, or Vytorin, reduces cholesterol more than either drug alone. But the combination hasn't paid off where it counts, in heart attacks and strokes prevented, or lives saved.

If Zetia or Vytorin is the first medication you've tried for lowering cholesterol, it makes better sense to try a statin all by itself instead. These drugs have been proven to prevent heart attacks and premature deaths from heart disease. If you can't tolerate a statin or it isn't enough, then niacin, plant sterols, and a cholesterol-lowering diet are good alternatives or additions.

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