Cholesterol Drug Has No Benefit in Trial

While Zetia lowers cholesterol by 15 to 20 percent in most patients, no trial has ever shown that it can reduce heart attacks and strokes — or even that it reduces the growth of the fatty plaques in arteries that can cause heart problems.

This trial was designed to show that Zetia could reduce the growth of those plaques. Instead, the plaques actually grew somewhat faster in patients taking Zetia along with Zocor than in those taking Zocor alone. Patients in the trial who took the combination of Zetia and Zocor were receiving it in the form of Vytorin pills.

Dr. Steven Nissen, the chairman of cardiology at the Cleveland Clinic, said the results were “shocking.” Patients should not be prescribed Zetia unless all other cholesterol drugs have failed, he said.

“This is as bad a result for the drug as anybody could have feared,” Dr. Nissen said. Millions of patients may be taking a drug that has no benefits for them, raising their risk of heart attacks and exposing them to potential side effects, he said.

When statins first hit the market, we believed that they worked primarily through cholesterol lowering. Some experts now believe that their main benefit comes from plaque stabilization and reducing coronary artery inflammation.

The data suggest that statins work regardless of the starting cholesterol level. Perhaps LDL cholesterol simply stratifies the risk of MI. The Zetia study suggests that lowering cholesterol is not as important as how one lowers the cholesterol.

These data add to our knowledge of the “cholesterol hypothesis.” This study calls into question having target goals for LDL cholesterol. Perhaps we should have treatment goals rather the outcome goals. I would suggest that being on a high dose statin works – we probably do not need to worry about the final LDL number.

These results will shake some readers faith in science. For me the results add to our understanding. This study affirms the value of scientific inquiry.

James Joyce said, “A man’s errors are his portals of discovery.”