I have a patient with severe coronary artery disease (he has already had quadruple bypass) and multiple risk factors for metabolic syndrome. His LDL goal is being met with ezetimibe 10 mg/simvastatin 80 mg (Vytorin 10/80). Given the results of the Ezetimibe and Simvastatin in Hypercholesterolemia Enhances Atherosclerosis Regression (ENHANCE) trial showing that Vytorin lowers cholesterol but does not reduce primary or secondary cardiovascular events, would you recommend switching him to rosuvastatin (Crestor) or atorvastatin (Lipitor)?
—John S. Rajapakse, MD, Woodbridge, N.J.

The discussion surrounding the ENHANCE trial presentation at the American College of Cardiology meeting in March 2008 appeared to reinforce the initial impression that ezetimibe (Zetia) has a limited (if any) role in the treatment of hyperlipidemia. While it is certainly acceptable to keep a patient on simvastatin only, the dosage will vary from patient to patient. Some patients may prefer to take a different statin, either out of confusion or anxiety (or both) about the role of simvastatin in contributing to the negative results seen with Vytorin. I would not argue with them.
—Peter F. Cohn, MD (124-10)