The Straits Times, April 11, 2008

Cholesterol drugs: Ask doc before dropping them

WE ARE concerned that the report, 'Two top cholesterol drugs may have no benefits' (April 1), may lead patients to stop taking their medications without first checking with their doctors. The article referred to Vytorin and Zetia.
Vytorin comprises 'Simvastatin' and 'Ezetemibe' combined, while Ezetimibe on its own is marketed as Zetia in the United States or Ezetrol in Singapore.

The time-tested role of 'statins' (for example, simvastatin) in lowering LDL cholesterol, thus reducing the risk of heart disease, is indisputable. Therefore, to say that both Vytorin and Ezetrol 'may have no benefits' is misleading.

Reducing the neck artery thickness, which was mentioned in the article, is one way to predict the risk of suffering a heart attack. However, getting the low-density lipoprotein (LDL) to desired levels is still of utmost importance in lowering one's risk of heart disease, and is an accepted national and international heart disease guideline.

To that end, our current practice, which remains unchanged, is to prescribe affordable generic statins at maximal tolerable doses before the addition of other cholesterol-lowering medications. Alternative cholesterol-lowering medications are considered based on the individual's concurrent medical conditions and cholesterol profile.

Ezetrol is one of the many choices to add on to statins when statins alone have failed to do its job. Therefore, we strongly advise that patients on Vytorin or Ezetrol discuss options with their doctors before discontinuing the use of either medication.

Doreen Tan
Senior Pharmacist,
Lipid Clinic & Cardiology Clinic, Alexandra Hospital,
Council member, Pharmaceutical Society of Singapore

Lee Siok Ying
Pharmacist, Lipid Clinic, Alexandra Hospital

Ong Hean Yee
Consultant Cardiologist, Alexandra Hospital

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