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Making Sense Of The Cholesterol Debate

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NEW YORK (CBS) The latest study presented at the 'Mecca' meeting for heart disease, the American Heart Association meeting, seems to add one more nail to the coffin against Merck, the drug-maker that makes many of the biggest cholesterol-lowering drugs. But, like many topics in medicine, this is no simple debate. Let's try to start from the beginning.

There is overall agreement amongst cardiology experts that lowering LDL (the 'bad' cholesterol) is the gold-standard in treating coronary heart disease. Statins, the class of drugs that lowers the body's own source of cholesterol, have been shown to do this. The challenge arises because many people cannot achieve a low enough LDL level with statin therapy alone or have side effects from statins when higher doses are used. That usually requires that another drug be used. Those drugs have included drugs like Zetia or Vytorin. Vytorin is a statin plus Zetia, and Zetia.

This study looked at the thickness of plaque build-up in the major artery in the neck, and used it as a 'surrogate end-point' or primary outcome measure, in stead of heart attack, stroke or death. It found that patients on Zetia had no reduction in plaque thickness, but those taking Niacin did. Limitations of the study include the relatively low number of patients involved in the study (just over 200), the relatively short period of follow-up (14 months) and the fact that no placebo arm was studied, as well as the fact that the study was funded by the makers of the prescription form of Niacin.

However, it did seem to raise questions about whether Zetia is effective and safe and whether or not a less expensive drug like Niacin can do as well or better in reducing heart attack, stroke or death. It is also important to mention that all drugs can and do have side-effects and that Niacin can cause liver toxicity and flushing, and so can be difficult to tolerate.

These will all be areas of future study, as the debate continues in the field of Cardiology.