People who have recently had a heart attack are encouraged to reduce their low-density lipoprotein (“bad”) cholesterol (LDL-C) to even lower levels than previously recommended, according to new guidelines.
A target goal of 70 mg/dl is urged for patients who have just had a heart attack or those who already have cardiovascular disease plus diabetes; who are persistent smokers; or who have high blood pressure or other multiple risk factors.
The FDA has approved Vytorin™, a combination tablet of generic ezetimibe (Zetia tablet, Schering-Plough), and drug simvastatin (Zocor medication, Merck). The medication combines a cholesterol blocker with a popular statin. It inhibits the production of cholesterol in the liver and blocks the absorption of cholesterol in the intestine, including cholesterol from food.
In a 12-week study, the drug reduced low-density lipoprotein cholesterol by 52% at the recommended starting dose (10/20 mg) and by 60% at the maximum dose (10/80 mg).
The new goals are expected to lead doctors to increase the use of drugs to reduce cholesterol levels when diet and exercise do not achieve the lower numbers. At least 36 million patients are candidates for statins.
Only 50% of patients are still taking cholesterol drugs a year after beginning the regimen, doctors say. A combination tablet might make it easier for patients to remember to take their medications.
A single product would also carry one co-payment and could be less expensive, but whether Vytorin™ will be economical will depend on its price.
For more information about Vytorin™, see the Pharmaceutical-Approval Update on page 507 of this issue of P&T.
More elderly patients at risk for congestive heart failure are getting aggressive statin therapy when they need it. Researchers from Kaiser Permanente Center for Health Research in Portland, Oregon, say that the 2004 update to the National Cholesterol Education Program Adult Treatment Panel III guidelines and the corresponding revision of internal guidelines in the large health maintenance organization they studied resulted in more patients receiving minimal-guideline statin therapy.
The FDA has approved the 4-mg maximum dose of pitavastatin (Livalo, Kowa), which is designed to improve blood cholesterol levels. Like other statins, this agent is indicated when diet and exercise fail to lower cholesterol levels.
