Study of new cholesterol drug
Publication Date:31/03/2008
Ezetimibe is a new kind of cholesterol medicine that stops your body absorbing cholesterol from food. Although it can reduce the amount of 'bad' cholesterol in the blood, it doesn't prevent narrowing of the arteries, according to newly published research. It's important that you don't stop taking any medicines you've been prescribed, without first discussing any concerns with your doctor.
What do we know already?
Cholesterol is a fatty substance that's found naturally in your body. You need some cholesterol to stay healthy. But if you have too much of the wrong kind of cholesterol, it builds up in your arteries and makes them narrow. This increases your risk of a heart attack or a stroke.
This 'bad' cholesterol is called LDL cholesterol. A high level of LDL cholesterol is linked to unhealthy fats in your diet, called saturated or trans fats. These are found in meat and dairy products, and in some fast foods, biscuits and baked goods. Exercise and a healthy diet can play a part in keeping your cholesterol level down.
Medicines can also be used to control your cholesterol. The most commonly used drugs are called statins. They help your liver clear 'bad' cholesterol out of your bloodstream.
A new kind of cholesterol medicine was launched in the UK in 2003. It's called ezetimibe, sold under the brand name Ezetrol. It works by stopping your body absorbing cholesterol from the food you eat. Eggs, offal and shellfish are all high in cholesterol.
Research has shown that ezetimibe can reduce the amount of 'bad' cholesterol in people's blood. But the point of lowering cholesterol is to try to prevent a heart attack or stroke. From 2002, researchers did a study looking at whether ezetimibe can stop people's arteries getting narrower. The idea was to get a better picture of whether the drug could prevent heart attacks and strokes.
There has been some controversy about the study. A committee of the US House of Representatives criticised the company that makes ezetimibe for not releasing the results quickly enough. The study was completed in 2006, but the full results have only just been published.
What does the new study say?
Ezetimibe doesn't stop narrowing of the arteries. The study looked at 720 people with a condition that causes high cholesterol. The patients all took a statin drug called simvastatin. Half of the people also took ezetimibe. The researchers used ultrasound scans to look for narrowing of the arteries in people's necks. People taking ezetimibe had the same build-up of cholesterol in their arteries as people who didn't take it.
The results of this study are surprising. Taking ezetimibe along with a statin did lower 'bad' cholesterol more than a statin on its own. But, despite this drop in 'bad' cholesterol, there was no reduction in the amount of cholesterol that built up inside people's arteries.
The researchers aren't sure why ezetimibe didn't have the benefits they thought it would. Lots of the people in the study had already been taking medicines for high cholesterol, such as statins, before the study started. This might have helped to control the narrowing of their arteries, and not left much more room for improvement. But even the people who hadn't taken statins before didn't do any better with ezetimibe.
The study didn't look directly at whether ezetimibe can prevent a heart attack or a stroke. But the researchers think that if it doesn't stop narrowing of the arteries, then it's unlikely to prevent these problems.
Where does the study come from?
The study was carried out at medical centres in countries all over the world, including the US, Canada, the Netherlands, South Africa, Spain and Denmark. It appeared in The New England Journal of Medicine, which is published by the Massachusetts Medical Society.
What does this mean for me?
Ezetimibe isn't the first choice of drug for treating high cholesterol. Statins are the drugs that doctors usually recommend, along with changes to your lifestyle. However, your doctor might say that ezetimibe is worth trying, perhaps if other cholesterol medicines don't work well enough on their own.
Ezetimibe can also be used for people who can't take statins. You might not be able to take a statin if it gives you side effects, or if it would interfere with other medicines you're taking.
What should I do now?
If you're taking ezetimibe, there's no need to worry. It's not clear whether it has the same benefits as other cholesterol drugs, but it does help to lower your cholesterol level, and it doesn't have many side effects. But if you want to discuss your treatment, make an appointment to see your doctor.
Several drugs can help lower your level of bad cholesterol, such as statins, fibrates and resins. Exercise and a healthy diet also play a part. If you have high cholesterol, your doctor will help you find the best combination of treatments for you. The treatment you need will depend on your overall risk of a heart attack or stroke, and not just on your cholesterol level.
From:
Kastelein JJP, Akdim F, Stroes ESG, et al. Simvastatin with or without ezetimibe in familial hypercholesterolemia. New England Journal of Medicine. 2008; 358: 1431-1433.
To read more, see our information on high cholesterol.
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This information does not replace medical advice. If you are concerned you might have a medical problem please ask your Boots pharmacy team in your local Boots store, or see your doctor.
