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There has been a lot of discussion lately about how the cholesterol drug Vytorin has failed to show how it decreases the risk of heart attack. Vytorin is a combination of two cholesterol-lowering drugs; ezetimibe and simvastatin. Drugs like simvastatin belong to a group of drugs known as ‘statins’. Statins have long been known to do an exceptional job of lowering cholesterol. Therefore it only seemed natural that adding a second drug to it, ezetimibe, would lower cholesterol even further.
Funny thing is, combining the two drugs DID result in overall lower cholesterol levels. The problem is, researchers are finding that this lower cholesterol does not necessarily mean a lower risk of heart attack. You see in this case, lower cholesterol is what is known as a ‘surrogate endpoint’. These types of endpoints are often assumed to reflect a drug’s effectiveness. The problem is, they don’t always reflect things accurately. For example, estrogens have been shown to improve cholesterol, but have been shown to actually increase the risk of heart attack and stroke. (continued below)
Keep in mind that there is currently no scientific evidence that shows that ANY combination of cholesterol-lowering drugs works better at decreasing heart attack than a statin alone. This is a problem. Millions of people are sold high-cost, brand name combination drugs for their cholesterol every day as first-line therapy. Since most statins have gone off patent and are available in a generic form, drug companies have long been looking for ways to extend the life of the statins they manufacturer. Rather than go back to the drawing board, they have found that combining them with another drug and marketing it under a new brand name is much easier.
As a result, marketing reps from these manufacturers spend a lot of time dropping off samples of their new combination drug to doctor’s offices. Doctors hand out these expensive brand name drugs as free samples to their patients as they are diagnosed with high cholesterol. The problem lies when the free samples dry up and the patient is left to pay for the prescription at the drug store. The assumption is often that, ‘newer is better’. This is not always true. Sometimes, it is the generic drug that has stood the test of time that is actually more effective than the newer, more expensive, brand name drug.
Experts do agree that this is only one study and that further studies are needed to confirm results. In the mean time, lowering cholesterol to prevent heart disease should still be the goal of treatment for those with high cholesterol. Remember that to date, statins are the most effective cholesterol-lowering drug. Statins should be first-line therapy for most people who have just been diagnosed with high cholesterol. Unless your cholesterol is exceptionally high or you have other health problems preventing you from using a statin alone, there are very few instances where a newly diagnosed patient would be given a combination product right off the bat.
There has been a lot of discussion lately about how the cholesterol drug Vytorin has failed to show how it decreases the risk of heart attack. Vytorin is a combination of two cholesterol-lowering drugs; ezetimibe and simvastatin. Drugs like simvastatin belong to a group of drugs known as ‘statins’. Statins have long been known to do an exceptional job of lowering cholesterol. Therefore it only seemed natural that adding a second drug to it, ezetimibe, would lower cholesterol even further.