To the Editor: Evidence is beginning to accumulate on the effectiveness of the low-density lipoprotein (LDL) cholesterol-lowering medicine ezetimibe. While there are no completed trials investigating ezetimibe’s effect on clinically important end points, two recent trials investigating its effect on carotid intima media thickness (CIMT) have both reported disappointing results.1,2 After each of these trials, the Journal has published editorials by Hamilton-Craig, who offers reassurance about ezetimibe and encourages ongoing prescription of this drug to patients who have elevated LDL levels despite maximum-tolerated statin therapy.3,4 Such a sanguine opinion seems at odds with the negative trial evidence, and therefore worthy of debate.
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- General Practice, School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Perth, WA.
- 1. Kastelein JJ, Akdim F, Stroes ES, et al; ENHANCE Investigators. Simvastatin with or without ezetimibe in familial hypercholesterolemia. N Engl J Med 2008; 358: 1431-1443.
- 2. Villines TC, Stanek EJ, Devine PJ, et al. The ARBITER 6-HALTS Trial (Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol 6 — HDL and LDL Treatment Strategies in Atherosclerosis). Final results and the impact of medication adherence, dose, and treatment duration. J Am Coll Cardiol 2010; 55: 2721-2726.
- 3. Hamilton-Craig IR. After ENHANCE: the cholesterol hypothesis is alive and well [editorial]. Med J Aust 2008; 189: 303-304. <MJA full text>
- 4. Hamilton-Craig IR. Managing residual risk in patients receiving statin therapy [editorial]. Med J Aust 2010; 192: 366-367. <MJA full text>
- 5. Barter PJ, Caulfield M, Eriksson M, et al; ILLUMINATE Investigators. Effects of torcetrapib in patients at high risk for coronary events. N Engl J Med 2007; 357: 2109-2122.