All,

I was just reading today in the New York Times that it's been revealed that Merck has conducted several trials of Zetia, used in combination with Statins, that raise questions about it's effect on the liver, but never published those studies.

Also, in the ENHANCE trial that they did publish, and which the FDA relied upon in approving the drug, some people who developed liver problems during the trial were dropped from the trial and their results excluded from it - and this fact was never included in the study results.

The article stated that studies have indicated that taking Zetia in combination with a Statin results in an 11 times greater chance of health problems than taking a Statin alone.

Canada has explicit warnings on Zetia and Vytorin notifying people of the potential for liver damage - but the FDA does not require these warnings on the drugs sold in the U.S.

Just a word of warning...

HubblRules
:cool:

Hi Hubble.....I'm not surprised, as they seem to be pushing that Zetia and Vytorin alot. My old dr. tried insisting on me taking the Zetia, but I refused it. After taking the few statins I did, and getting so sick, I swore off of them..PERIOD! Reminds me of the old Baycol thing, which I have first hand knowledge of that lousy drug.

Thanks for the post, and by the way, Merry Christmas, and a very Happy and healthy New Year. :)

Thanks for the post, and by the way, Merry Christmas, and a very Happy and healthy New Year. :)

JJ,

Hi;) - haven't seen you posting lately - welcome back!!!

Merry Christmas and Happy New Year to you also!!!

Put that 'Flipper' movie on and dream about Beach Bumming....

HubbleRules
:cool:

Yeah Hubble, seems the old crew went by the wayside. Hope all is well with you and the family. Same old, same old here, but we are still kicking. ;)

Definately want to kick back and think of spring, already have had too much ice and freezing temps. Give me that Beach Bum life for sure.

Keep healthy, and enjoy your holidays. :)

All,

There's more bad news for Zetia (and Vytorin) in the papers today.

They did a new trial that "failed to show that the drug had any medical benefits".

It reduces cholesterol by 10-15%, but when combined with Zocor, it actually increases the rate at which arterial plaques form over using Zocor alone.

Whoever is taking Zetia or Vytorin should do some research <removed>

HubbleRules
:cool:

Hi All,
Just watched an article on ABC news this evening that after a 2 year study on zetia "in Humans" that it is proven to have no effects on cholesterol or heart disease, it went on to say that people with high cholesterol should stick to the older cholesterol lowering drugs... not this person...dont know what exactly im going to do.. but after being off zetia and lipitor for almost 3 or 4 months im still paying for it. What is the story on cholesterol and inflamation? saw it in a post. help me out here. thanks

Gee, Merck's batting a 1000. And they withheld the negative study data for about two years. Lucky you if you happened to use Vioxx and took Zetia or Vytorin. But their commercials said they REALLY care.:jester:

Of course, I've been taking Vytorin and it's the only cholesterol drug that's ever lowered my cholesterol to under 200. I'm having my annual physical in 2 weeks, so I'll talk to my Dr. about it then. I used to take Zocor, but it didn't lower my cholesterol enough. Everyone in my family has high cholesterol. I wish I had just stayed on Zocor already.:confused:

All,

I wouldn't do anything right now if you are currently taking Vytorin or Zetia.

I would schedule a follow-up with my doctor and discuss the sitation. But chances are, you probably are better off switching to a different medication.

Regards,

HubbleRules
:cool:

This all goes back to the idea some doctors hold that cholesterol is more of a marker rather than the primary causative of cardiac disease. The science is still not clear but knowledgeable physicians believe the problems stem from underlying inflamation processes. What causes the inflamation and how to prevent it are not totally clear. What is clear though is that low cholesterol is in not ,by itself, an guarantee of cardiac health.

mmvic,

I agree completely - there's a lot more to CHD than just cholesterol levels.

Sadly, at this time, I think there's more that we don't know than do about how to effectively prevent CHD.

I think some of the drugs under development that target cell receptors and which can interrupt the inflammation response are probably going to do more good than those we have available to us today.

HubbleRules
:cool:

I'll be seeing my Dr. in 9 days and will discuss it with him then. I'll let you know what he says.

... What is clear though is that low cholesterol is in not ,by itself, an guarantee of cardiac health.
So this study suggests that reducing cholesterol doesn't reduce plaque buildup. And it was always assumed that plaque buildup caused heart attacks. Other studies have shown that using statins reduces heart attack risk. Which raises the question, if it isn't cholesterol, what causes heart attacks? It seems to lend weight to the inflammation hypothesis, that inflammation causes plaque to rupture and cause heart attacks and strokes.

What really amazes me about all this is the way mainstream experts have responded. Questioning the use of cholesterol-reducing statins would be the expected response. Instead they are simply advising the use of statins alone. I suppose a little bit of plague buildup is better than a lot of plaque buildup ... ;)

So this study suggests that reducing cholesterol doesn't reduce plaque buildup. And it was always assumed that plaque buildup caused heart attacks. Other studies have shown that using statins reduces heart attack risk. Which raises the question, if it isn't cholesterol, what causes heart attacks? It seems to lend weight to the inflammation hypothesis, that inflammation causes plaque to rupture and cause heart attacks and strokes.


Lipid subfractions probably play a role, which I think the Zetia study didn't even go into. LDL doesn't cause heart atacks. Small LDL particles do (most likely). I believe Zetia also reduced a sub-fraction of HDL too (I forget which study showed this), which isn't such a good thing.

So inflammation + an abundance of small LDL + high Lpa + low HDL = heart disease? That may be as good a guess as any, I suppose.

Glucose or glycogen maybe one of the primary bad actors since they have been shown to have an irritating effect on the vascular system. There maybe other bad actors also such as low grade infections, viruses and so on. This spectrum of irritants plus genetic predispostion account for the lack of knowledge for the disease.

LDL and LPa may in fact be markers for the underlying process -much like what has been discerned for C reactive protein. Statins are known to impact inflammatory processes , the changes in cholesterol maybe coincidental and just the marker changing as the inflammatory process is suppressed. The interesting thing is that RYR changes cholesterol much more than the actual dosage of statin would dictate so the other monaconlins could be impacting inflammatory processes. Drug companies will never pursue this since there are no patents here.:D Zetia has no impact on inflammation so no help with cardiac disease despite the drop in cholesterol. I would expect we see the same results for plant sterols/stanols since they also lower cholesterol but do nothing for inflammation.

I've been on Vytorin for two years (10:40), following a long run on Lipitor.

I've had CAD and other coronary complications for many years. I'll talk to my cardiologist about this at my next appointment in two weeks, but I'm not about to panic. The doctor put me on Vytorin in an attempt to lower LDL, and it's gone from 100 down to 70 with an accompanying 7 point increase in HDL (45 to 52).

But thanks Hubble for posting this. It does, of course, raise questions.

Bill 1950,

I wouldn't panic either if I were you. Talk to your doctor about the Vytorin next time you see him - maybe he'll suggest a different medication.

Good news for you - when LDL is brought down to 70 or lower - studies have shown significant plaque reduction.

What bothers me most about this Zetia / Vytorin situation is that it is so indicative of how corrupting the pursuit of profit is in health care.

Merck knew for 19 months about the negative study results, but said nothing. This is surely not the first time negative results have been postponed or totally withheld for profit motives either. At least as insidious is the practice of 'dropping' people with negative results from a study. Seems like cherry-picking the results to me.

Oh well, enough ranting for one evening.

Best of luck...

HubbleRules
:cool:

I've also taking Zetia a few years. Already have CHD so i thought it was a good thing. Now i read the report i wonder. Talked to my general pratictioner and he said the study should never have been released. So i called my cardio doctor and i'm awaiting word. If he says nothing to convince me i am going to drop Zetia and keep taking my zocor.

.... Talked to my general pratictioner and he said the study should never have been released. ....
That is so typical! ... Doctors like it when their patients don't know what is going on. Big pharma will only stop selling us junk when we, the consumers, tell them it is not good enough.
... i called my cardio doctor and i'm awaiting word. If he says nothing to convince me i am going to drop Zetia and keep taking my zocor.
The ENHANCE study shows quite convincingly that reducing cholesterol doesn't protect us from heart disease. So why would you want to continue with Zocor?

Mark

The ENHANCE study shows quite convincingly that reducing cholesterol doesn't protect us from heart disease. So why would you want to continue with Zocor?

Mark

The study doesn't show this. All it shows is that Zetia isn't effective in preventing heart disease. This may be because reducing cholesterol doesn't matter, or because the lipid sub-fractons Zetia reduced (or didn't reduce) played a role. Anyone out there find out if the Enhance study covered lipid sub-fractions or did it rely on standard cholesterol testing?

Statins can help some people, depending on overall risk factors. If this is due to lipid changes, inflammation reduction, or some other factor, I'm not sure if anyone exactly knows.

.... Statins can help some people, depending on overall risk factors. ....
That may be so, but it seems this protection does not come from reducing cholesterol.

That may be so, but it seems this protection does not come from reducing cholesterol.

Yeah, this is probably true, at least for some people. Those with super high (genetic) cholesterol levels might be a different story... not sure.

Inflammation reduction could be the main protective action of statins. Or it could be that it shifts LDL from small particles to large. There is also a theory that statins are a vitamin D analogue, and D levels are what protects the heart.

It'd be nice if they did more studies to figure out why statins do help some people. It is entirely possible that fish oil + vitamin D would protect against heart disease more than any statin would, regardless of cholesterol changes.