Even though there remains some room for debate about the role of Zetia and Vytorin, and there remains uncertainty in the field overall about the desirability of treating patients to acheive numerical goals, the bell certainly seems to be tolling for the legacy Merck/Schering-Plough partnership's flagship offering: Vytorin. Especially so, at the astronomical prices New Merck expects for the drug -- a drug that no one seems comfortable saying will actually reduce heart attack risks.
It seems Forbes, and Mr. Herper, could not source a single independent and reputable expert quote -- to defend its use, as a first-line treatment. Do go read all of Mr. Herper's careful, well-researched and well-reasoned article, but here is a taste:
. . . .Doctors currently use drugs to try to get patients' LDL down to a specific target--for most people the target is 120 milligrams per deciliter. But Yale cardiologist Harlan Krumholz and University of Michigan internist Rodney Hayward say this is unnecessarily complicated. Instead, they recommend doctors estimate people's total cardiovascular risk using a multiple risk factors like high blood pressure and age. People with a 15% or higher 10-year risk of suffering a heart attack should get a healthy dose of Lipitor (40 mg); everyone else should take generic simvastin, also at a 40 mg dose. Krumholz and Hayward calculate this method would prevent more heart attacks than bothering with numerical targets, while allowing patients to take lower doses of drugs. . . .
The bottom line: Cardiologists don't know [nearly] as much as you might think about high cholesterol. But they do know that you should watch your diet and exercise. If you are still at risk of a heart attack, consider taking a statin drug like Lipitor or generic Zocor. . . .
Just look at that conclusion -- I think it is an accurate depiction of where most medical professionsals now land, on the Vytorin/Zetia question: it has been effectively answered, at least until 2014 or so (when IMPROVE-IT might be completed, and then published) -- and there is no first, second or third line spot for the drug. There is much more in the article -- including analysis of the Arbiter-6 HALTS termination, among other matters.