Zetia does not reduce carotid plaque size when added to zocor

January 15, 2008
Cardiovascular News Update

Dear Colleague,
Westside Medical Associates of Los Angeles (WMALA) in conjunction with
Westside Medical Imaging (WMI) would like to provide you with this weekly
update on important new developments in cardiovascular care.

Zetia does not reduce carotid plaque size when added to Zocor.
Zetia (ezetimibe) "may not actually prevent heart attacks and strokes," according to the long-
awaited results of the Enhance trial. Typically, patients "take Zetia in the form of Vytorin
(ezetimibe and simvastatin), which combines Zetia with Zocor (simvastatin)." Zetia and Vytorin
are jointly marketed by Merck & Co. and Schering-Plough Corp.
Zetia reduces cholesterol 15 to 20 percent in most patients, no trial has been completed yet
that has ever shown that it can reduce heart attacks and strokes -- or even that it reduces the
growth of the fatty plaques in arteries that can cause heart problems. The Enhance trial "was
designed to show that Zetia could reduce the growth" of fatty plaques in arteries. However,
"the plaques actually grew by 0.005 mm more in those taking Zetia along with Zocor than in
those taking Zocor alone."
The trial was conducted by a group headed by Dr. John J.P. Kastelein of the University of
Amsterdam Medical Center. All 720 participants suffered from an unusual condition known as Early
heterozygous familial hypercholesterolemia. Vytorin cut "LDL levels by 58 percent, compared detection
to a 41 percent reduction with simvastatin alone. However, the researchers found that "the
saves lives.
average thickness of the carotid artery plaque increased by 0.0111 of a millimeter in patients That’s what
we do. Find
taking Vytorin, compared to an increase of 0.0058 of a millimeter in" those taking only out more at
simvastatin. According to Dr. Norman Lepor, Westside Medical Associates of Los Angeles and Westside
an expert on the treatment of hyperlipidemia, “The complete clinical trial results will be Medical
researchers plan to present their data in March at a meeting of the American College of Imaging’s
Cardiology." He also said that “ one should not confuse the very, very small increase in carotid website at
plaque dimension with a risk of cardiovascular events, as this event data has not yet been presented. Since there do not seem to be any safety issues, there is no urgency to having patients taken off Zetia and replaced with either higher doses of statins, niacin or resins until the full clinical trial results are presented.” PPI drugs may block anti-clotting medication in stent patients, study suggests.
While acid-reducing proton pump inhibitor (PPI) drugs such as Prilosec (omeprazole) "prevent
gastric bleeding in stent patients on Plavix (clopidogrel bisulfate)," the drugs may also "block
Plavix's lifesaving anti-platelet action," according to research published in the Jan. 22 issue of
the Journal of the American College of Cardiology. For the study, Martine Gilard, M.D., of
Brest University Hospital, Brest, France, and colleagues looked at 124 heart patients who
received stents to open stenotic coronary arteries. All patients were given Plavix, and 50
percent of them also received Prilosec. The researchers "tested the patients' blood using a
measure of clotting activity that is not routinely used in the U.S. Following one week of
treatment, the researchers "found that patients who took Plavix plus Prilosec were more than
four times more likely to be 'poor responders' to Plavix than were those" given only Plavix. The
key question as to whether this is associated with clinical events has not been answered. Often
times PPI’s are taken by patients who may not need them or longer then their condition may
require. It may be prudent to decide whether a patient who has undergone a coronary stent
and is on dual antiplatelet therapy needs to be on that PPI.
Statins may reduce heart risks in diabetes patients, research suggests.
Statins reduce heart and stroke risks in people with diabetes and should be more widely used
for these patients," according to research published in the Lancet medical journal. Researchers
at the University of Oxford and the University of Sydney "looked at the health records of 18,686
people with diabetes, both inherited and acquired," who had participated in 14 different
clinical trials. The researchers found that those who took statins reduced their risk of
developing cardiovascular disease "over a five-year period by about 33 percent compared with"
diabetes patients "who didn't take the drugs."
According to the researchers, for every 39 mg/dL drop in LDL cholesterol, people with diabetes
cut their risk of major heart events by approximately 20 percent. A typical dose of statins cuts
LDL cholesterol by 57 mg/dL, which would lower this risk by one-third."
The authors wrote that present guidelines might need to be revised to ensure that a statin
regimen which is sufficient to produce a substantial reduction in LDL cholesterol is considered
for all people with diabetes, irrespective of whether vascular disease has developed and
irrespective of lipid profile.
Incorporating healthy amounts of omega-3 fatty acids into diet may soon
become easier.
The federal National Institutes of Health concluded after a massive review three years ago that
consuming omega-3 fatty acids cuts the risk of death from heart attacks and other
cardiovascular causes, can reduce the joint pain of rheumatoid arthritis and may also be
"mportant for proper brain development and function an individual may need to take fistfuls of
capsules in order to receive the health benefits seen in clinical trials. However, it may soon
become easier to get such hefty doses without taking so many pills, as a growing number of
foods are fortified with omega-3. They also noted that a number of scientists believe omega-3's
benefits flow primarily from its ability to damp low-level inflammation, which is thought to be
a key culprit in just about every major scourge of aging, from clogged arteries to Alzheimer's.
Some recent studies suggest that taking small doses of aspirin daily, which many people do to
prevent heart attacks, magnifies the anti-inflammatory effect of taking fish oil.
Research suggests link between oatmeal and cholesterol reduction may be
stronger than once thought.
The relationship between oatmeal and cholesterol reduction is stronger than initially" thought,
according to a review published in the American Journal of Lifestyle Medicine. Dr. James W.
Anderson, of the University of Kentucky College of Medicine, and colleagues "analyzed studies conducted during the past 15 years on oatmeal and cholesterol and found without exception total cholesterol levels were lower after oat consumption." Furthermore, the researchers found that LDL cholesterol decreases "without adverse effects on" HDL cholesterol "or triglyceride concentrations." Westside Medical Associates of Los Angeles (WMALA) and Westside Medical Imaging
(WMI) are premier centers in cardiac diagnosis and treatment.
Please feel free to contact
or Ivor Geft MD
at (310) 289-9955
or check our website at

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Source: http://www.westsidemedimaging.com/newsletters/01-15-08.pdf