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Cholesterol-reducing drug ezetimibe appears to do more harm than good

Posted Jun 10 2011 5:42am

Cholesterol is said to cause heart disease (I’m not so sure, myself), and a mainstay of treatment here is a class of drugs known as ‘statins’ that reduce the rate at which cholesterol is manufactured in the liver. Statins have been used in medicine for over 20 years, but more recently has seen the development and licensing of a cholesterol-reducing drug known as ezetimibe, which works in different way to statins. Instead of acting on the liver, it reduces cholesterol absorption from the gut.

There’s no doubt that ezetimibe reduces cholesterol levels effectively, and it is licensed on this basis. However, the impact that a drug (or food or anything) has on cholesterol is irrelevant – it’s its impact on health that matters. While we have been brainwashed into believing that whatever reduces cholesterol is good for health, this simply isn’t true. Actually, there is abundant evidence that reducing cholesterol per se is not broadly beneficial to health. And some evidence suggests that it might even be damaging to health.

As it happens, ezetimibe use has been linked with an increased risk of cancer, and enhanced narrowing of arteries (though not statistically significant) [1], as well as an increased risk of cancer in one study [2].

Ezetimibe is a drug that reduces cholesterol levels in the bloodstream. It does this in a different way to statins (the most commonly-prescribed cholesterol drugs). Statins work by inhibiting the rate at which cholesterol is manufactured in the liver, while ezetimibe impairs the absorption of cholesterol from the gut.

Ezetimibe was originally licensed on the basis of its cholesterol-reducing abilities. Yet, to date, no study has ever been published which demonstrates that it has the power to reduce the risk of actual disease or death. In fact, in one study, coupling ezetimibe with a statin (simvastatin) resulted in increased (though not statistically significant) narrowing of the arteries compared to the statin alone [1].

I was interested to read a recent study in which ezetimibe was again tested for its affects on narrowing in the arteries (atherosclerosis) [3]. In this study, individuals with ‘peripheral vascular disease’ (atherosclerosis in the arteries in the legs) had the extent of their disease measured using MRI. Here’s how the individuals in the study were treated:

1. those not previously on a statin were given simvastatin (40 mg a day) or simvastatin (40 mg a day) plus ezetimibe (10 mg a day).

2. those already taking a statin had ezetimibe (10 mg a day) added to their regime.

MRI was repeated after 1 and 2 years. Here’s what the results showed:

Overall, ezetimibe resulted in lower ‘unhealthy’ LDL-cholesterol levels when used in conjunction with the statin than the statin alone. However, individuals in group 2 saw a progression of their disease (by 8 per cent over two years), compared with no progression in group 1.

In other words, in those taking a statin, the addition of ezetimibe actually worsened their disease.

This study, on the back of previous evidence, strongly suggests that ezetimibe poses hazards for health. Yet, it remains on the market. This is what can happen when our attention is diverted away from the truly important thing (health), towards cholesterol or some other supposed marker of disease.

References:

1. Kastelein JJ, et al. Simvastatin with or without ezetimibe in familial hypercholesterolemia. NEJM 2008;358(14):1431-43

2. Rossebø AB, et al. Intensive Lipid Lowering with Simvastatin and Ezetimibe in Aortic Stenosis. NEJM 2008;359(13):1343-56

3. West AM, et al. The effect of ezetimibe on peripheral arterial atherosclerosis depends upon statin use at baseline. Atherosclerosis. 2011 Apr 16. [Epub ahead of print]

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