January 22 , 2007
Erik N. Steele, D.O.
The recent news that the cholesterol-lowering medication Vytorin may lower your cholesterol but not prevent blockages in the arteries around your heart (the kind that can lead to angina and heart attacks) has a lot of patients and physicians scratching their heads. Everyone thought that if you lowered cholesterol levels that fewer arterial blockages would result, so that any medicine which lowered cholesterol would work to reduce blockages. But in Vytorin’s case, a recent medical study suggested maybe not, leaving patients and their physicians wondering if patients should be taken off Vytorin and put on something else.
The study actually did not look at blockages in heart arteries, because doing so requires heart catheterizations to measure blockages and that is an expensive procedure with some risk to it. Instead, patients on Vytorin had ultrasounds of the carotid artery in the neck to see if partial blockages there were reduced as Vytorin drove cholesterol down; the carotid artery was being used as a kind of ‘surrogate’ for the heart arteries. Unfortunately, the study found that carotid artery blockages did not go down even as cholesterols went down.
The whole issue was made even more frustrating because Vytorin (a combination of two cholesterol-lowering medicine) costs a lot – about $100 per month – and it did not work any better than one of its component medicines Zocor. That medicine is now available as a generic medication for about 1/3 the cost of Vytorin, which is only available in the more expensive, name-brand form. That has some Vytorin patients and physicians who take care of them not only wondering if the medicine is not working well to prevent blockages, but also wondering if the patient is paying a lot of unnecessary money for something that may not work as well as hoped.
So what do you do if you are on Vytorin? First, talk to your physician about the issue; don’t just stop the pills in frustration and throw your cholesterol caution to the wind. Second, if you are at very high risk for a heart attack already (you have had a heart attack, are diabetic, are a smoker over the age of 50 or so, you may want to talk to your physician about using a cholesterol-lowering medication that has been specifically shown in studies to reduce your risk of heart attack (such as Pravachol / pravastatin) or Lipitor. You may not be a good candidate to wait for the larger studies that are in the works looking at Vytorin effectiveness in more patients and with designs specifically to see if Vytorin reduces heart attack risk and heart artery blockages.
Finally, regardless of what medicine you are taking, you can do a better job reducing your heart attack risk by eating right, getting to a healthy weight, exercising regularly, and not smoking, etc. than you can by taking Vytorin or any other cholesterol-lowering medicine. If you are worrying about whether your Vytorin is working but not doing those other things, or are driving around without your seatbelt while talking on your cell phone, you are worrying (and barking) up the wrong risk tree.