Taking a daily aspirin won’t prevent heart deaths in those without established heart disease, but taking the combination cholesterol-lowering drug ezetimibe plus simvastatin (Vytorin) could prevent heart attacks and strokes in high-risk heart patients who recently had a heart attack or life-threatening chest pain, according to two research studies presented Monday at the American Heart Association’s annual meeting in Chicago.
The Vytorin finding was hailed as good news since it found that adding a non-statin drug (ezetimibe) to a statin drug (simvastatin) to lower levels of “bad” LDL cholesterol reduced heart attacks and strokes, both by about 14 percent, compared to taking a statin drug alone in 18,000 heart patients who participated in a clinical trial sponsored by Vytorin manufacturer Merck.
“The study is the first to show that adding a non-statin drug to a statin to improve cholesterol levels can help patients with specific heart problems do better,” Dr. Christopher Cannon, study lead author and a physician at Brigham and Women’s Hospital, said in a statement.
While Vytorin lowered levels of LDL cholesterol more than simvastatin alone, it did not reduce deaths from heart disease or strokes in the group of high-risk heart patients who participated in the study. All had recently experienced acute coronary syndrome, a potentially deadly condition where blood supplied to the heart muscle is suddenly blocked.
“These study results will help expand our treatment options for high-risk ACS patients, especially among those who are intolerant of or who do not achieve desired results with intense statin therapy,” said Dr. Lori Mosca, director of Preventive Cardiology at New York-Presbyterian Hospital who was not involved in the study. “They further suggest that we should consider setting the LDL bar even lower among our high-risk patients to achieve maximum benefit to prevent recurrent heart disease and stroke,” she added.
Whether healthy people who have elevated cholesterol levels and no signs of heart disease could gain added protection from heart attacks and strokes by adding Vytorin to their statin regimen remains unknown.
Updated cholesterol-treatment guidelines issued last year by the American Heart Association recommend that doctors prescribe more potent, higher-dose statins as a first-line treatment while abandoning other cholesterol-lowering drugs such as ezetimibe and gemfibrozil.
Using aspirin to prevent heart deaths in those without established heart disease also remains a murky question for doctors to contend with.
A Japanese clinical trial, published in the Journal of the American Medical Association, involving more than 14,000 patients ages 60 to 85 years of age with heart disease risk factors like hypertension, high cholesterol, or diabetes found that taking a daily aspirin provided no protection against heart disease deaths or non-fatal heart attacks or strokes compared to taking a placebo for five years. The trial was stopped early after researchers determined that aspirin provided no benefits.
“Aspirin is indicated for patients at high short-term risk,” such as those who had a heart attack, stroke or procedure to open a clogged heart artery, wrote Dr. J. Michael Gaziano, of Brigham and Women’s Hospital, and Dr. Philip Greenland, of Northwestern University Feinberg School of Medicine, in an editorial that accompanied the study. “On the other hand, patients at very low risk of vascular events should not take aspirin for prevention of vascular events, even at low dose.”Deborah Kotz can be reached at firstname.lastname@example.org. Follow her on Twitter @debkotz2.