These studies light up my lines

First estrogen in the post-WHI days. Then Avandia after studies linked this diabetic drug to an increased risk of heart disease in a population already at enormous risk of same. Now Zetia hits the headlines, and patients hit speed-dial to Capitol Hill Internal Medicine.

For those of you not yet chasing your cholesterol numbers, Zetia is a cholesterol-lowering medication that works in an entirely different manner than the statins such as Zocor (simvastatin) or Lipitor. For that reason, persons unable to tolerate statins or those whose cholesterol levels do not fall sufficiently with statins can be switched to Zetia alone for a 15% drop in their LDL levels or to Vytorin which teams Zetia with Zocor for an even larger reduction in LDL than Zocor alone.

When we monitor cholesterol levels to gauge the success of treatment, we are actually looking at 'surrogate markers.' We don't have any practical way of monitoring the actual health of your inner arterial wall, so we know, based on mountains of data from years of studies, that LDL-cholesterol levels tend to correlate with the amount of gunk in your arteries and the risk that they will ultimately block off under a heap of goo and clot.

Well, we used to know that. New data* from the ENHANCE trial suggests that, when it comes to Zetia, lower LDL levels do not necessarily translate into lower risk. This study followed 720 patients over 2 years (note small trial size and short trial duration), comparing IMT (intima media thickness of the carotid arteries which uses ultrasound technology to indirectly measure wall thickening in neck arteries**) in subjects on Zetia and Zocor vs. those on Zocor alone.

The results showed not a whit of difference between the combination of the Z drugs (aka Vytorin) and Zocor alone. Vytorin and Zetia are brand name only drugs, thus more expensive and far more lucrative to the manufacturers, while Zocor is available generically. Dr. Steve Nissen, an outspoken cardiologist from the Cleveland Clinic, is emphatically urging docs to abandon Zetia. Industry-backed investigators are hedging.

Hmm, what to say to those callers?
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*Actually, it is oldish data that has only been newly released, and perhaps only released under pressure from a congressional committee.
**IMT is also a surrogate marker,