Popular cholesterol-lowering drugs revealed: "They just don't work."

Candid Camera

Dear Member,

I was tempted to glance around and look for a hidden camera while watching television coverage of the most recent controversy about the cholesterol-lowering drugs Vytorin and Zetia. Come on, I thought. Someone is setting me up. This is way too absurd to be real.

Well, we’ve had that feeling before, haven’t we? When mainstream experts start talking about the effectiveness and safety of cholesterol-lowering statin drugs, there seems to be a mile-wide disconnect between the words they speak and the reality behind those words.

March madness

On the weekend before April Fool’s Day, a panel of cardiologists told attendees at a large cardiology conference that a two-year trial reveals that Zetia and Vytorin don’t do what they’re supposed to do, reduce arterial plaque.

Zetia cuts dietary absorption of cholesterol, and Vytorin combines Zetia with Zocor, a statin. In other words, Vytorin should be a double-whammy powerhouse of a drug that reduces LDL cholesterol (which it does) and arterial plaque (which it apparently does not).

Many of those conference cardiologists were probably hoping to hear an “April Fool!” after this distressing news was delivered. They heard just the opposite: As the New York Times reported, the combined drugs “might have even sped up the growth of fatty plaques in the arteries.”

To make matters worse, these unpleasant details (originally reported in January) landed in the convention spotlight on the same day the New England Journal of Medicine published the study, along with not one but TWO accompanying editorials.

What a mess! Especially for the five million patients worldwide who are currently taking either Vytorin or Zetia.

Talkin’ the talk

The mainstream media knew what to do with this news: Spin it! And while you’re at it, make sure you sell some statins.

That Monday after the convention, I happened to catch the Today Show where the Vytorin/Zetia bombshell was given top billing in the first half hour of the broadcast. Matt Lauer interviewed NBC News Chief Medical Editor Dr. Nancy Snyderman who offered a quick review of the study, hinting ever so delicately that these drugs had gained widespread popularity among doctors and patients who hoped to avoid statin side effects – you know, those side effects that are always referred to as “rare” in statin commercials.

Then Matt stepped into the patient’s shoes, wondering what a patient should say to his doctor who’s previously prescribed Zetia or Vytorin.

Dr. Snyderman: “Ask, ‘Why am I on these?’ And if your doctor can’t give you a very good answer, say, ‘You know what? Let’s try an old statin. AND let’s try it at the maximum dose where I seem to be able to tolerate it and only use these medications as a last resort.’ They’re not dangerous, they just don’t work.”

Not dangerous! NEJM reports there was a “slight increase” in the thickness of artery walls. How is that not dangerous!? And they “don’t work,” but they should be used as a last resort? A last resort for what – a drug salesperson who needs to meet his quota?

Amazing. And what little detail did Dr. Snyderman leave out of her recommendation? One of the NEJM editorials actually suggests that patients who are unable to lower LDL cholesterol with statins should do two things: 1) renew their efforts to exercise and control their diets, and 2) try niacin.

Niacin. Which is vitamin B3. Which HSI members have been reading about for years as a reliable supplement that improves LDL to HDL ratio, lowers triglycerides, and reduces heart attack risk while also supporting cognitive function.

But of course, Dr. Snyderman isn’t getting paid to sell niacin.

Sources:
“Simvastatin With or Without Ezetimibe in Familial Hypercholesterolemia” The New England Journal of Medicine, Published online ahead of print, 3/30/08, content.nejm.org
“Cholesterol Lowering and Ezetimibe” The New England Journal of Medicine, Published online ahead of print, 3/30/08, content.nejm.org
“Doubt Cast on 2 Drugs Used to Lower Cholesterol” Alex Berenson, The New York Times, 3/31/08, nytimes.com