What’s the Deal With Zetia (Ezetimibe): A Good Alternative to Statins for Preventing Heart Attack and Stroke?

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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When I read criticisms of doctors prescribing expensive medications that might not benefit patients at all, I think of Zetia (ezetimibe) as the poster child. News came out last week after the IMPROVE-IT trial that seemed to pump it up, but what we learned from this large trial may surprise you and let you down at the same time.

  1. Billions and billions of dollars have already been spent on Zetia—despite not knowing whether it has any benefit to you other than lowering LDL cholesterol a little bit. Does it improve your mortality or lower your risk of heart attack? We don’t know.
  1. It’s attractive because it’s one of the only non-statin options for lowering cholesterol and does not cause muscle pain or elevation of liver function tests.
  1. It will cost you and your health insurance plan more money. A 30-day supply is about 200 dollars.
  1. Despite this recent study making the news (done on people who had just had a heart event in the last 10 days), if you are a patient without heart attack in the last 10 days the question of any benefit to you is still completely unknown.
  1. What did this new study tell us about Zetia? That 50 people who have just had an acute coronary event have to be treated with both simvastatin and Zetia (compared to simvastatin alone) for 7 years to prevent ONE death, heart attack or stroke. What? Yep.
  1. It’s about the high dose statins, not Zetia. What guidelines in the United States do recommend you take after a coronary event is atorvastatin (Lipitor) 80 mg or Crestor 40 mg for high risk patients, and that does save lives.
  1. So remember what we know about Zetia. For a price of 200 dollars a month if you add it to simvastatin and take it for 7 years after having a heart event there is a one in 50 chance that this compound will help you.
  1. We have no idea if LDL lowering with ezetimibe should be widely used elsewhere other than in high risk patients after a heart event.

Dr O.

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