There are many cholesterol-lowering medications on the market today, but which of these drugs improve health and save lives? Just because a drug lowers cholesterol doesn’t necessarily mean that it will do either. What do the latest research studies tell us about Zetia, one of the most popular cholesterol medications?

Zetia has been advertised as better at treating cholesterol and heart disease than its competitors. About 70 percent of people who take Zetia take it as Vytorin, which is a combination of Zetia and another cholesterol-lowering drug called simvastatin, (commonly known as Zocor). With about 1 million people a week getting prescriptions for Zetia, it is important to know just how safe and effective this new drug really is.

After Zetia was approved by the Food and Drug Administration, the drug companies that make it, Merck and Schering-Plough, conducted a two-year clinical trial of 720 patients. Half the patients were given either Vytorin (the combination of Zetia and Zocor) and half were given Zocor alone.¹ The results of this study were supposed to have been released in March 2007, however they were not made public by Merck until January 2008 and weren’t published in a peer-reviewed journal until March 2008. When they finally were made public, the results indicated that patients taking the Zetia-Zocor combination drug (Vytorin) were at the same risk for heart disease as the patients who took Zocor alone.

Zetia had been previously shown to reduce cholesterol by about 15-20 percent, which makes it a better cholesterol-lowering medication than traditional drugs like Zocor. However, Zetia had not been shown to prevent the buildup of fatty plaques on the insides or arteries that commonly lead to heart attacks and strokes. The goal of this study was to prove that the combination of Zetia with Zocor is better at reducing this buildup than Zocor alone, which would indicate that it is probably more effective at preventing strokes and heart attacks.¹

However, the results show that while Zetia combined with Zocor is more effective at lowering cholesterol, it is not better at reducing plaque build up in the arteries than Zocor alone. On the contrary, the arterial wall was somewhat thicker for patients taking both drugs.¹ In fact, 2 patients taking the combination pill died, compared to one taking Zocor, and 3 of the patients taking the combination pill had non-fatal heart attacks, compared to 2 taking Zocor. None of these differences were statistically significant¹, but they all suggest that Zocor alone is a better choice than Zocor combined with Zetia. The bottom line is: why take a combination of two drugs that has no clear health benefits compared to taking just one of the drugs?

Doctors and patients had assumed that Zetia is worth taking because it is effective at lowering cholesterol. Now that these results have been published, doctors are being advised that Zetia should only be used if all other medications have failed. It is important to keep in mind that lowering cholesterol is a means to an end (better health), not a sign of health in and of itself. And, of course, all drugs have unwanted side effects and potentially serious risks. The listed side effects for Zetia include: stomach pain, tiredness, allergic reactions, and joint pain. Rarely, patients also experience severe muscle problems with symptoms of muscle pain, tenderness, or weakness caused by muscle breakdown.² If a drug that lowers cholesterol does not improve health, and other drugs are more likely to improve health, then the risks outweigh the benefits.




References

1. Kastelein, J et al. (2008). Simvastatin with or without Ezetimibe in Familial Hypercholesterolemia. The New England Journal of Medicine. 358, 14: 1431-1443

2. FDA Patient Information Sheet: Ezetimibe (marketed as Zetia). (July 2006). Retrieved from: http://www.fda.gov/Cder/drug/InfoSheets/patient/ezetimibePIS.htm