Is more bad news reason to give up on cholesterol drugs? Doc says no

A national conference of cardiologists was in an uproar this week after a panel of experts said that Zetia and Vytorin, two of the best-selling drugs in the world, should be used only as a last resort to lower cholesterol.

The report -- and the reaction among doctors -- is also causing a lot of confusion among patients, said Dr. Kevin Graham, director of interventional cardiology at the Minneapolis Heart Institute, who is attending the weeklong conference. The nurses at his clinic are getting calls from people asking whether they should stop taking the drugs, he said. Zetia blocks cholesterol. Vytorin is a combination of Zetia and another widely used cholesterol-lowering drug, Zocor.

The short answer, he said, is not yet.

The study, first made public in January, found that Zetia and Vytorin lowered cholesterol but failed to slow the growth of fatty plaque in arteries.

That is closely tied to low density cholesterol and leads to heart attacks and strokes.

On Sunday, the results were formally published online by the New England Journal of Medicine and presented at the American College of Cardiology conference in Chicago.

Graham answered questions Monday about the new research, the drugs and the best advice he can give for the moment about what patients should do.

Q: What are you telling your patients?

A: If there are other drugs that get you to your cholesterol goal, that's fine. But in the absence of that, we want you to get your LDL (low density lipoproteins) down. It will be a few years before we find out whether (Zetia and Vytorin) have an effect on hard events. Heart attack. Death. Stroke. The biggies. Nobody can say that right now. They have not been shown to do harm, and people who are at high risk, the biggest thing is to get their LDL down.

Q: Why is this research so controversial among cardiologists?

A: Everybody is really angry at the drug companies (Merck and Schering-Plough) for holding this out. They suppressed this for a year to two years. Numerous people got black eyes. The companies did. Researchers felt they got painted with the same brush. But what we don't want is for patients to get a black eye. People lose sight of why we do this -- to keep patients from having a heart attack and stroke and die. Between 1998 and 2005 in Minnesota, the deaths from heart attacks have dropped 40 percent. It's not like we're bumping off people.

Q: These drugs are now being used by 5 million people around the world, including 4 million in the United States. They generate $5 billion annually in sales. Why are they so popular?

A: Many other LDL drugs don't have a huge market because they don't work. They are hard to take. People get bloating. Health plans don't cover them, and then people have to go to a slurry you drink twice a day. Our biggest issue is compliance. Women, more so than men, will not take (some drugs with side effects) long term. Here was a drug that worked the same, but with one-tenth the side effects. And (Vytorin) came in one pill, so patients had only one co-payment.

Q: What about the statin drugs that are also widely used? Why aren't those enough?

A: You get the biggest bang for your buck with statins. But there are side effects with high dose statin drugs. This is the dance that clinicians go through.

Q: How much can diet and exercise reduce cholesterol?

A: Five to 10 percent. But it depends on where you start.

Q: Some experts have suggested that lowering cholesterol to rock bottom may not do as much for patients with coronary artery disease as everyone believed. Lower is better has been the guideline for decades. Does this study throw that open to question?

A: No. Every other study says that with lower LDL, people do better. That has been proven. That's why this (study) is surprising.

Josephine Marcotty • 612-673-7394