Go with the generic
It was fun this morning, watching the contortions of the morning anchors as they tried to spin the bad news about Zetia without admitting the plain, simple truth.
If your cholesterol is high go with the generic.
While Zetia and Vytorin, which combines Zetia with Zocor (the name brand for a generic statin) did reduce "the numbers" your doctor looks to as markers for heart disease, they don't cut plaque, the fatty deposit that clogs arteries and causes an attack.
The generic name for Zetia is ezetimibe. The generic name for Zocor is simvastatin.
The specific study in question dealt with folks who have super-high cholesterol levels due to a genetic defect. The numbers went down but there was no impact on heart attack rates.
Insurers' criticism was more direct. The U.S. wasted $1.5 billion on Zetia over the last five years.
This number was calculated by comparing total payments for cholesterol-lowering drugs over the last six years, $19.5 billion, with what would have happened if we followed the Canadian example. They never approved Vytorin and have long banned direct-to-consumer drug advertising.
Of course, there's another potential implication, one which is much more frightening to drug companies and, face it, to heart patients like me.
That is, managing to the number, those LDL and triglyceride numbers your doctor checks ever six months (once you go on statins), may be meaningless.
My opinion is that once the plaque is there, dropping fat levels in the blood won't get rid of it. And it's possible that plaque attracts plaque.
I go back to something I wrote in December, from the Emory Predictive Health conference. Keeping plaque from forming is key. Low-dose statins at younger ages may make sense, to prevent it, based on western diets which are high in fat.
But once you have plaque, we don't know how to get rid of it. Lowering cholesterol may slow its growth, but LDL cholesterol and triglycerides are just a gross indication of other things going on, enzymatic processes we have yet to fully understand.
"Lowering cholesterol does not necessarily reduce heart attacks, strokes and deaths," Dr. Steven Nissen of the Cleveland Clinic told CNBC this morning.
This "scandal," in other words, is an opportunity to dig deeper into the question.