Vytorin is effective at lowering cholesterol, but the more important question is whether patients who take it will be less likely to have a heart attack or stroke, need heart surgery, or die. The goal of cholesterol-lowering medication is to help patients live longer and avoid serious heart disease, but studies of Vytorin show that it isn’t effective at reducing atherosclerosis (clogged arteries), so experts believed it was unlikely that Vytorin would decrease the risk of heart attack or stroke. The company that makes Vytorin thinks it will and they recently completed new research that they hope will prove it.
Vytorin is a combination of two different drugs, simvastatin (Zocor) and ezetimibe (Zetia). Both these drugs lower cholesterol, but in different ways. Simvastatin is a statin drug and reduces cholesterol production while ezetimibe lowers cholesterol by blocking its absorption. Vytorin lowers cholesterol more than either of these drugs alone. But that does not mean that Vytorin helps prevent heart attack, stroke, or death, compared to just taking simvastatin (Zocor) alone.
A study optimistically called the IMPROVE-IT study, published in 2015, aimed to answer this question.1 Researchers paid by the company that makes Vytorin studied more than 18,000 people who had a recent heart attack or chest pain to see whether Vytorin improved patients’ health more than simvastatin alone. They found that 35% of the patients taking only simvastatin had heart attacks, strokes, hospitalizations, or heart surgery, compared to 33% of those taking Vytorin.
That’s a very small improvement and, although Vytorin reduced the chances of having a heart attack or stroke by 2%, it did not reduce the chances of dying or needing heart surgery. If 350 patients who previously had a heart attack or chest pain take Vytorin instead of Zetia, only one will be prevented from having a stroke or another heart attack in the next year. To prevent one heart attack or stroke would cost 350 patients $7 per day ($2,555 per patient per year for a total of $900,000), compared to taking a generic form of Zocor for about 25 cents per day ($91.25 per patient per year).
A well-known cardiologist, Dr. Eric Topol, points out that Vytorin would be even less helpful for patients who have never had a heart attack. Although physicians sometimes prescribe Vytorin to men and women who never had a heart attack, there is no evidence that it will help them, compared to the much less expensive generic Zocor. If your physician recommends Vytorin to you, you may want to ask: Why not prescribe generic Zocor instead?
Are there any substantial advantages of Vytorin? Statins have painful side effects for some patients. However, since Vytorin contains a statin, it is equally likely to cause those side effects as Zocor or other statins.
All articles are reviewed and approved by Dr. Diana Zuckerman and other senior staff.
- Cannon CP, Blazing MA, et al. Ezetimibe Added to Statin Therapy after Acute Coronary Syndromes. N Engl J Med. 2015 Jun 18;372(25):2387-97