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If Medical Studies Raise Questions, Don't be Rash

Dr. David Lipschitz

A new scientific study shows that a blockbuster medication may not be as effective as once thought.

This time, researchers found that the cholesterol-lowering medication Vytorin was no more effective in reducing plaques, or deposits of fat and cholesterol, in carotid arteries than its generic counterpart.

With more than 100,000 prescriptions written for Vytorin each day, this recent information is causing consternation for physicians and patients. Does this mean a patient using Vytorin should stop taking the drug? Is Vytorin unsafe? The answer to both questions is "No." However, it's important that everyone learn to cut through the media hype and understand the medical ramifications of any new information.

Vytorin is a combination of Zocor, a generic statin that lowers cholesterol by inhibiting the production of the bad or LDL cholesterol in the liver, and Zetia, a newer agent that prevents cholesterol absorption from the gastrointestinal tract. Zocor and Zetia lower cholesterol, and the combined effect is greater than each of the drugs alone. So, rather than forcing physicians to prescribe two pills to be taken together, Merck came to the rescue by developing Vytorin and generating revenue through a new, patented drug.

Although this recent research shows that Vytorin has not been particularly effective in reducing arterial plaque, it does reduce LDL cholesterol to a lower level than the generic Zocor alone. In an ideal situation, Vytorin should only be used when Zocor, the only generic statin, is not effective in lowering cholesterol to the target level. It should never be the first line of treatment for lowering cholesterol.

So how should elevated cholesterol be treated? Everyone should have their cholesterol level measured around age 30 and, in certain circumstances, even earlier. This is because some individuals have a genetic predisposition to massively elevated cholesterol that often causes a heart attack at a very young age. Thereafter, cholesterol should be measured each decade until age 50 and every five years thereafter.

Anyone with a total cholesterol level above 200, LDL cholesterol above 130 and a ratio of the LDL to the good, or HDL cholesterol, above five should have their cholesterol lowered. Depending on other risk factors such as age, sex, high blood pressure, diabetes or a strong family history of heart disease, your doctor could be more or less aggressive in treating high cholesterol.

When combating high cholesterol, the first course of action should always be diet and exercise, which is frequently sufficient. In general, the LDL cholesterol is used as a marker of effective care, with a target level of 100 unless you have coronary artery disease, in which case you should aim for a level below 70.

However, if lifestyle changes are not enough, then treatment with a medication should be considered. Every patient should initially be treated with Simvastatin (generic Zocor). The dose should be gradually increased until the LDL reaches the target value. If this does not happen, two options are available. The first is switching to a more powerful (and expensive) statin such as Lipitor or Crestor. If, despite using maximum doses of Lipitor or Crestor, the target cholesterol is not reached, Zetia can be added for good effect. Alternately, Vytorin could be tried. The advantage is that the cost is half the combination of Lipitor or Crestor combined with Zetia.

If you are using Vytorin and feel it may not be the best medication, consult your physician before making any rash decisions. Do not, under any circumstances, stop taking your medications. Discuss the information with your doctor and decide the best approach for you. If you have never been treated with a statin alone, you should consider switching to Zocor. Until more information becomes available, Lipitor or Crestor should be used alone before adding Zetia or switching to Vytorin.

The message is simple. If you hear a negative report about any medication you are taking, don't stop it without having a discussion with your doctor first. Make sure you truly understand the implications of any new information, especially when it comes to the hype or hysteria surrounding a new therapy.

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Dr. David Lipschitz is the author of the book "Breaking the Rules of Aging." To find out more about Dr. David Lipschitz and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com. More information is available at www.drdavidhealth.com.

Source:
Lifelong Health
ArcaMax Publishing
http://www.arcamax.com