Comments on Cholesterol Management 101: Zetia and Vytorin: Let's Look at the Facts

Zetia has a very high NNT score that makes it usel...

2008-12-08T12:55:00.000-05:00

Zetia has a very high NNT score that makes it useless in preventing a cardiac event. Even the drug manufacturer admits this.
Your chances of winning the lottery are better.

My husband took Zetia for 7 days and had a severe,...

2008-11-18T18:57:00.000-05:00

My husband took Zetia for 7 days and had a severe, uncontrollable emotional reaction to it. He ended up hospitalized. He is unable to take any of the statins due to becoming unable to walk from muscle breakdown. He also can't take niacin as it creates major vision problems. That doesn't leave many options.

I was a big fan of Vytorin but now I'm not so sure...

2008-10-11T06:04:00.000-04:00

I was a big fan of Vytorin but now I'm not so sure. I was on it all last year and brought my overall number down from 245 to 106. Earlier this year I got my butt into the gym and dropped 30 lbs and reached an near ideal weight of 190 lbs at 6'3". I work out regularly, run, drink water like a champ, and vastly improved diet/food choices, etc. Feeling good about my lifestyle changes, I decided to try to come off Vytorin in April. Blood test in Sept showed my number had gone back up to 190 so I was told to restart. It's been about 3 weeks now and 1-2 times a week, I'm experiencing serious stomach pain (enough to visit CVS at 3am). I did not have any intestinal distress before but since my restart (and 30 lbs lighter with better diet, etc) and experiencing side effects and may have to switch. -thought I'd share...

Is very low cholesterol dangerous? My total is 84...

2008-04-22T22:36:00.000-04:00

Is very low cholesterol dangerous? My total is 84,
HDL 31, Non HDL 53, Ratio 2.7, triglycerides 69. I have started an exercise program so hopefully my LDL will come down. I was on Vytorin due to a higher ratio, but since the scary report I asked to be switched and now I'm on Crestor which I am concerned about. Thank you

This is the second time I’m responding to this sub...

2008-04-19T17:10:00.000-04:00

This is the second time I’m responding to this subject; for some reason, my two cents occasionally are not applied to the blog. Here goes again:

I have been on Lipitor since 1999. In Oct 2006, I had an MRA that revealed my left carotid was about 40-45% blocked, which, I was told, was not cause for alarm. I was put on Vytorin in January of 2007 to further lower my cholesterol, which was about 190 at the time.

In November 2007, another MRA revealed that the left carotid was now more than 90% blocked. I had immediate surgery. The Zetia/Vytorin study broke about a month later, and my family doctor placed me back on Lipitor alone.

Since I’m 63, that means that arithmetically, it took me 62 years to block my left carotid 45%, but only 13 additional months to double that blockage. Or could it have been the Zetia (in the form of Vytorin) that caused the rapid increase?

Was Disraeli right, i.e., that there are three kinds of lies—lies, damn lies, and statistics? Or can there be a connection between my use of Zetia and an increase in artery blockage?

I was taking Zetia alone with good results until m...

2008-04-07T03:35:00.000-04:00

I was taking Zetia alone with good results until my ldl's shot way up. I then started a regime of Fish oil, and Flaxseed oil caplets twice a day, and in 3 months brought everything back towards a normal range. I am now off of Zetis, but am not sure if I should get back on it. I will call my Dr. tomorrow and ask. I am having leg tightness in both legs and am wondering if this is one of the side affects of discontinuing Zetia?

I'd like to put my 2 cents in here.My doctor put m...

2008-04-04T12:41:00.000-04:00

I'd like to put my 2 cents in here.
My doctor put me on Zetia a few years ago due to elevated LDL. I took it for approximately 6 months and then had blood work again. My cholesterol totals including LDL actually shot up nearly 20% while paying out more than $500 for the drug! So I knew Zetia was never effective, but was actually nothing more than an over priced placebo. Knowing that now and seeing the news today, I wish I had suied the Schering Corporation! Since then I've experienced 2 very bad side effects involving severe muscle and joint pain after taking both Lescol and Tricor. Never again will I take another statin!

I was going to write a response to try to explain ...

2008-04-03T23:01:00.000-04:00

I was going to write a response to try to explain why the Enhance study is very relavent and a negative trial that should change clinical practice, but I thought it much easier to direct you all to view the recommendations straight from the American College of Cardiology(ACC) expert panel that was convened to analyse the results from Enhance w/ Vytorin(Zetia). They were selected by the ACC because they are unbiased experts that could make recommendations at the Annual Scientific session which is a meeting of over 20,000 cardiologist from around the world. All of you who are on Vytorin or Zetia, are considering it, or have family members on it, must watch this short 10 minute video of the actual panel discussion. The panel was made up of national thought leaders who are experts in the field of lipids and clinical research. Go to cardiosource.com/rapidnewssummaries/acc08.asp Once at the web site, scroll down to Sunday March 30. Then look for "Effect of Combination Ezetimibe and High-Dose Simvastatin vs. Simvastatin Alone on the Atherosclerotic Process in Patients With Heterozygous Familial Hypercholesterolemia (ENHANCE) – John Kastelein". It is the second to last listing under Sunday March 30. I highly recommend that you view the "Panel Discussion Video" listed here. If you also have time you can view the presentation of the trial itself listed as "presentation video", however it might be a bit too scientific for some to follow. The panel discussion is more relevant because this is the consensus opinion of ACC national experts in this field. You really must all watch this; including Dr. Richman. Let me know your thought afterwords.

Numbers don't aways tell the truth.Are the numbers...

2008-04-01T10:14:00.000-04:00

Numbers don't aways tell the truth.
Are the numbers from Vytorin cometic ??? I am real concerned
when they tell me the plaque is still building even tho my numbers all show they are in the good range. I take Vytorin but have NO
confidence that it is doing the job....

I appreciate the posts from the Dr's. and other po...

2008-03-31T21:51:00.000-04:00

I appreciate the posts from the Dr's. and other posters. Hearing the news today on the radio was just another "shock" report for the media.

I have been taking a variety of statins for over 12 years and by themself I couldn't get my numbers where they needed to be and I run 5 days a week, eat right, etc... For the past couple of years I have been using Vytorin 10/40 and it has brought all of my numbers where they need to be.

I was taking Lipitor for about 8 yrs and was havin...

2008-03-30T13:29:00.000-04:00

I was taking Lipitor for about 8 yrs and was having increased muscle aches to the point I felt I shuld try something else. It as controlling all lipid levels well.
I switched to Vytorin 10/20 from
Lipitor 40mg. After 6 months my lipid levels were still good. The last lipid test after 18 months on Vytorin showed my Tri level shot up from 88 to 182. My muscle ache
seems to be better but now I have
Gerd, somach burn/ache, heart burn, insomnia. I am concerned about the Tri being high...?

I am glad to have found this site. My husband was ...

2008-02-14T10:58:00.000-05:00

I am glad to have found this site. My husband was on 5 mg of Crestor. His blood test in mid-December showed that his LDLs were 180 and Triglycerides were 200. His doctor wanted to bring them down further, and put him on Zetia in combination with the Crestor. His blood test two days ago (mid-February) showed that his LDLs went down to 38, and his triglycerides are now 1239 (this is NOT a typo). They are doing further testing now. The nurse told him that people rarely react to Zetia this way, but it does happen.
As a side note, I would like to add that he is only about 10 pounds overweight and we have not made any changes to our diet in the last two months. He is also not on any other medications, nor does he drink or smoke. Blood pressure and sugar in excellent condition.
As you can imagine, we are both at a loss for words, and quite afraid of him suffering a heart atttack or worse.

I have been on this drug about a year I have less ...

2008-01-31T19:37:00.000-05:00

I have been on this drug about a year I have less aches and pains on it then lipator my ldl has lowered a lot I trust it and do beleave it is helping me.

Dr. Richman-I was taking gemfibrozil for a number ...

2008-01-28T17:40:00.000-05:00

Dr. Richman-

I was taking gemfibrozil for a number of years for lowing triglycerides. Suddenly in 2004, the drug apparently stopped working and I had a heart attack in Jan. 2005. I was 56 at that time.

I was put on Crestor 10mg for about 2 years and after noticing joint and muscle failures, I was put on a dose of 5 mg and continued taking that dose for about another 6 months. Even at that dose, I was having more and more trouble, but the test results were always great.

Finally the side effect was just to debilitating and my doctors put me on Zetia alone. I have been on it for about 6 months now and I feel much better and the joints and muscles do as well.

Finally, I do have the same problem that the doctor who wrote to you mentioned........increased triglycerides. Where they were at 75 while taking the Crestor, they have now risen to 175. My HDL/LDL and total cholesterol are all fine.

Since you mentioned that you hadn't noticed the increase in triglycerides in your patients taking just Zetia, I thought that I would substantiate the good doctors story with my own account.

I was also interested in your suggestion of taking a very low dose of the statin every few days. I wonder if this would work for me and be able to lower my triglycerides. Perhaps I will mention it to my doctors and see what they make of it. I sure wouldn't want to start the joint and muscle weakening/pain again though.

Allen

I want to make a few comments regarding your quest...

2008-01-24T18:08:00.000-05:00

I want to make a few comments regarding your question. First of all, too many physicians are quick to say that patients are intolerant to statins. I do not have any patients that cannot take some statin. I have a few patients who had documented Rhadomyolysis on a statin and they seem to do well on a very low dose every other day or every third day. They just need to be monitored closely. Stains have outcome results and Zetia does not so Zetia should not be used as the first line agent unless all things really do fail which is extremely rare. Zetia should be added first rather then raising the statin dose, as dose escalation leads to increasing problems while each doubling of any statin dose will lower LDL-C around 7%. I personally have not had any patients with elevating Triglycerides while on Zetia but you may want to try one of the agents used to lower Triglycerides. Remember that LDL particles are the villain and need and need to be aggressively removed from the body as they traffic the cholesterol into the arterial wall and cause Atherosclerosis

As a family practitioner I have been grateful for ...

2008-01-24T08:46:00.000-05:00

As a family practitioner I have been grateful for the Zetia option in my patients intolerant of statins. I have however noticed a subset of my patients develop dramatically increased triglyceride levels on Zetia, even when chole levels respond. I typically discontinue the med when I find that. Did the ENHANCE study note this? Could this explain the progression in some patients? I would love any feedback on this.

I was very disheartened last friday evening when I...

2008-01-23T17:24:00.000-05:00

I was very disheartened last friday evening when I watched the CBS national news and Katie Couric was interviewing some "expert' who said that statins were not necessary in low risk patients for a Cardiovascular event. First of all I will define low, moderate, high, and very-high risk. This is based on the Framingham Risk Assessment which is made up of 5 variables. I personally believe that it is very antiquated and there are new and emerging risk factors that are not even taken into account. Nonetheless, one does not qualify for scoring unless they have at least 2 of the major risk factors for CAD and it is known to underestimate the risk of a CV event in women. Low risk is defined as 0-10% risk of an event in 10 years, moderate risk 10-20% chance, high risk > 20% chance, and very high risk is > 20% chance with a Coronary Artery Disease equivalent. What about the risk at 20 or 30 years? Framingham does not take that into account. I was happy last night to see that the AHA released statistics showing that stroke and heart attacks were down about 25% since 1999. This is due to improving cardiac care and all the "experts" I heard interviewed said it was due in large measure to the liberal use of statins. I completely agree with this. I will soon continue my series on the safety of lipid lowering drugs. I have already covered the effects on the liver so I encourage everyone to read it cause I am still getting questions regarding the effects of statins on the liver on my message board. Most of the questions should be answered in that post. My next blog post will be on the effects of statins on muscle.

you all have to remember that Zetia is a Systemic ...

2008-01-22T22:22:00.000-05:00

you all have to remember that Zetia is a Systemic drug menaing it is metabolized in the liver and travels the bloodstream. Zetia is a Cholesterol Absorption blocker, meaning it keeps that bacon cheezeburger from being absorbed. You can have elevated liver enzymes on Zetia. Zetia affects your body like a statin but it is an extremely lower dose. I tried both a statin and Zetia but could not tolerate either. Zetia caused elevated liver enzymes like the statin. Now I take a drug called WelChol, it does not enter the bloodstream, the liver, or kidneys. It has lowered my cholesterol by about 22% and my Dr. says with my increasingly better diet and more exercise I could reach my LDL goal. I have read all I can about these drugs we take and WelChol is a safe drug to take if you want an alternative.

The Doc was not able get my cholesterol down, with...

2008-01-22T21:00:00.000-05:00

The Doc was not able get my cholesterol down, with several other statins. He put me on Zetia and my LDL dropped quickly. I have had by-pass 9 yrs. ago. Since then he has also put me on 5mg. of crestor, my LDL, trigly. and HDL are all in the upper 50's now. and have reamined that way for the past 2-3 yrs. my total is 127 now!

I was on Lipator for a few years and my cholestero...

2008-01-22T17:59:00.000-05:00

I was on Lipator for a few years and my cholesterol did not come down at all. I've been on Vytorin 10/40 for 6 months almost to the day. I went for my annual blood test just last week and my LDL dropped from 267 down to 160. I have no ill side effects from this medicene and will continue to take it on my Doctors advise.

I took Zocorstarting at 5 mg per day and had to in...

2008-01-21T23:43:00.000-05:00

I took Zocorstarting at 5 mg per day and had to increase it until I got to 20 mg. My LDL kept going up as tho the Zocor was causing it to increase. Finally with the addition of Zetia, my LDL dropped until I was back on the lowest dose Zocor I could go-5mg. There I will stay for the Cardioprotective nature of the medication.My whole family is on this combination with success. Thanks.

With so many other problems, I am glad that I can ...

2008-01-21T22:42:00.000-05:00

With so many other problems, I am glad that I can just trust my longtime dcctor. Having taken Lithium for bipolar for 32 years, my kidneys stopped excreting it and I had a stroke. Having recovered, I was placed on Seroquel which I knew raised blood sugar level, but I have been on it now for 3 years and am so much better. I feel as though I should have never taken Lithium. Anyway, the Seroquel first gave me acid reflux so I get that treated. A couple of weeks ago the doctor checked my cholesterol and it was 325! He put me on Vytorin and I began to immediately feel better. Before I was placed on that I felt weak, tired and had body aches.

I read the report on it but as long as I feel better on what I take I will trust the good Lord to instruct my doctor to make the right decisions for me.

Dr. Richman, you assert that " statins... have wit...

2008-01-21T18:59:00.000-05:00

Dr. Richman, you assert that " statins... have without question reduced CV risk dramatically."
1. Could you quantify what you mean by dramatically and to what population are you referring?
2. Could you please post the journal names, dates, authors, and titles of articles detailing the results of reasonably large, well-controlled, replicated studies that support that assertion? Although I strive to keep my own lipid numbers in the approved range, I am beginning to have doubts about the diet-cholesterol-CVD hypothesis.
Thanks.

I am a victim of Simvastatin where after taking it...

2008-01-20T23:31:00.000-05:00

I am a victim of Simvastatin where after taking it for two months all my muscules where attacked to the point of being unable to walk.Statins are evil to some and generic drugs are not always a deal moneywise.I have been on Zetia for six months and my total cholesterol has dropped 50 points and my LDL has dropped 30 points.For me the price for Zetia is well worth it compared to using a walker which is what I was sent home with from the hospital.

My husband has been taking Vytorin for about 2 yea...

2008-01-20T19:30:00.000-05:00

My husband has been taking Vytorin for about 2 years. In that time he has had surgery on both carotids and a quadruple bypass. He has bad muscle pain. He can't walk for long periods. Just going to the grocery store tires him out. He is only 53 and it has changed our lives completely. He has had all kinds of tests and they cannot find a cause for the muscle fatigue and pain. He sees his cardiologist and other doctors religiously.
We just cannot get an answer for his muscle problems and yet his plaque build up continues.