Saturday, November 22, 2014

Thanks Go Again To My Commenters, Here: Another Revision To Cholesterol/Heart Guidelines In The Offing?

Many of my best leads for new stories come from comments I receive, privately, or here (or on the back-up site) in the comment box.

Today's story is straight from that latter source, offered just yesterday. [I've also answered some pro-Zetia® commenters on the backup site, during the week -- as a result of the IMPROVE-IT outcomes.] I think many doctors find the new guidelines too hard to distill -- to a simple, patient friendly sort of sound-bite. So I do suspect they will be rewritten. I am not so sure they will return to the specific "60 or lower" type of simplicity.

The emerging evidence in the scientific world is clearly more complicated and nuanced than such a sound bite might imply. And the results of IMPROVE-IT are too modest (see graphic, at right) to make a single simple goal number the end of the chase, in my opinion. So I bet we will see new guidelines for the second time in two years, some time next year. But they won't be a "prescribe Vytorin® or Zetia® over all" type of pronouncement. That much is certain. Here is FiercePharma, on it all:

. . . .Among drugmakers, there are potential winners and losers, whichever way doctors land. Merck's Zetia and Vytorin, which combines Zetia with its statin Zocor, have seen falling sales, combined about $4 billion last year. The two were written off by some analysts after the guidelines changed last year.Those guidelines moved away from basing drugs on getting LDL below a specific to prescribing statins for patients at high risk because they share a family history, or smoke, for example, with those at the higher risk, like diabetes patients, getting the highest doses. The new rules meant a lot of people not taking statins should be prescribed them, favoring drugs like generic Lipitor, but not drugs like Zetia. . . . [A]lso standing to win is a new class of drugs, PCSK9 inhibitors, that are designed to lower LDL by more than 50%. Amgen, Regeneron and Sanofi are working in that arena.

Dr. Matthew Sorrentino, a preventive cardiologist at University of Chicago Medicine, told Reuters he relies on the new guidelines but understands the appeal of having a specific LDL target to shoot for. "Almost everybody knew what the LDL target was," he said. "I can see making the guidelines easier to follow. . . ."

In any event, the Zetia portion goes generic in 2016. So, whatever else happens, it will be short lived, for Merck. You heard it here first. Now, go enjoy your cardio-workouts, healthy diets and low stress lifestyles -- and avoid these pills entirely! Smile!

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