| 7. | 4/25/2008 2:59:00 PM | Neither Vytorin or Zetia has been shown to be unsafe in any study thus far. Zetia alone or in combination with a statin medication has been a useful tool for physicians to get patients to the AHA goal of LDL < 70 in certain disease states. Especially in patients that can not tolerate statin medications or reach goal with max doses of statin medications. As both scientists and health care providers, we have to realize that medicine is not a perfect science. Until they understood disease mechanism, physicians used bloodletting to treat pateints. They didn't do it because they wanted to hurt patients, they did it because they wanted to help. Clearly science and medicine has and continues to make advances in treatments. Not knowing is not always doing harm. Zetia may not help, but neither has it show to hurt patients. Plaque progression, stability, and rupture is not an exact science. Clinical data supports that LDLs at a certain level correlate with better outcomes. We really have no idea exactally how LDL cholesterol contributes to that process which without question is not only mediated by plaque formation. Until the AHA changes their guidelines to reflect that having an LDL of 70 or lower isn't really as helpful as they thought it previously was -I'm going to continue to strive for that goal for myself, my loved ones, and my patients. It seems arrogant to ignore the ACC expert report, but I have met alot of physicians throughout my training and professional career. I realize that just because you are named an expert doesn't really mean that you know everything about your area of expertise and often expert offer opinions rather than evidenced based advice. I wish the ACC would issue a responsible report to the mass media something like this....We recognize that the ENHANCE study failed to show a significant difference in overall carotid plaque regression when compared to similar doses of a statin medication alone; However, this study was designed to measure radiologic endpoints in a population of patients with a rare, inherited form of elevated cholesterol. We can't tell from the ENHANCE study results if these results can be applied to other bloodvessels in the body or even if overall plaque thickness is the most important factor in whether you will have a vascular event such as a heart attack or stroke. We do know after many studies that if your cholesterol is less than 70 in certain diseases the risk for those events is decreased. Zetia/Vytorin have not to date been shown to be harmful and there are ongoing, more appropriate studies to help us to answer these questions. Your doctor may chose to change your medication, but if you can't take a statin medication or are already taking as high a dose as you can, Zetia/Vytorin may be good option for you. That's how I feel and that's what I tell my patients. my family, and anyone else who asks me. |