Alternative to statins to help heart patients
IN THE first discovery since statins have been regularly used to lower cholesterol, a large study - in which doctors and heart patients in Singapore participated - showed that a similar type of drug can protect people from heart attacks and strokes.
The benefits of Vytorin - whose active ingredient is made in a plant in Tuas and distributed for use worldwide - can help millions at high risk of heart attacks who cannot tolerate statins or do not respond to them sufficiently, according to a New York Times report on the findings.
Some had argued that statins reduced heart-attack risk not just by lowering low-density lipoprotein (LDL) levels - the dangerous form of cholesterol - but also by reducing inflammation. The new study indicates that the crucial factor is LDL, and the lower, the better.
The six-year study involved 18,000 people who had had heart attacks or episodes of chest pain so severe that they went to hospital. They were assigned randomly to take a statin or a combination of a statin and the alternative drug to further reduce LDL levels.
Both groups ended up with very low LDL levels - those taking the statin, simvastatin, had an average LDL of 69; and those taking simvastatin and the other drug, ezetimibe, or Zetia, in a combination pill sold as Vytorin, had an average LDL of 54.
Daniel Yeo, the investigator for the study in Singapore when he was at Tan Tock Seng Hospital, said 75 patients here took part in it.
All were high-risk patients, with the majority having already had a heart attack. But all also had good LDL levels of less than 100.
The target for people with multiple risk factors and a previous heart attack is an LDL reading below 80.
Dr Yeo, now a cardiologist in private practice, was happy with the positive results of the study: "As doctors, we're always looking for new drugs to help patients."
Statins lower LDL by preventing it from being made. Ezetimibe lowers LDL by preventing cholesterol from being absorbed in the gut.
Among those assigned to take Vytorin worldwide, there were 6.4 per cent fewer cardiac events - heart disease deaths, heart attacks, strokes, bypass operations and stent insertions.
Christopher Cannon, a principal investigator and cardiologist at Brigham and Women's Hospital, said it means that two out of every 100 people who would have had a heart attack or stroke by taking the statin avoided those outcomes by taking the combination drug.
The study was sponsored by Merck, the maker of Vytorin, but the investigators had the right to publish what they wanted, with the final say over what they wrote.
Thousands of patients suffering from high cholesterol levels in Singapore can benefit from a 50 per cent discount on this drug - which sells for roughly $3 a pill - under the MSD Assist scheme launched last year by pharma giant MSD Pharma (Singapore). MSD is a tradename of Merck.
The scheme allows Pioneer Generation and Community Health Assist Scheme cardholders to pay only half the price for Vytorin and 23 other commonly used drugs.