The combination of ezetimibe and a statin to lower cholesterol reduces the risk of heart attack or stroke

High cholesterol is a key culprit in the development of cardiovascular disease, the leading cause of death in the United States and many other developed countries. We know that lowering cholesterol helps prevent heart attacks and strokes. But it remains an open question: How low should you go? New research published online today in the New England Journal of Medicine suggests that less is better.

Cholesterol and Cardiovascular Disease

Cholesterol circulates in the blood in two fundamental particles: high density lipoproteins (HDL) and low density lipoprotein (LDL). It neutralizes HDL cholesterol in the blood circulation and within the walls of the artery and it takes to the liver for disposal. This so-called "good" cholesterol helps reduce the risk of heart disease. LDL is often called "bad" cholesterol, increasing the risk of heart disease. When too much circulating LDL, some of which carries cholesterol is deposited on arterial walls. These deposits, called plaque, can lead to heart attack or stroke.

Keep your lower LDL levels is essential to maintain the health of your heart. The pillars to control LDL reduce saturated and trans fats in your diet, maintain a healthy body weight and exercise regularly. When these lifestyle changes are not enough to lower LDL cholesterol, doctors usually prescribe drugs called statins. Statins reduce the amount of LDL in the blood by reducing hepatic LDL production. Because the liver needs cholesterol for a variety of tasks, it responds by pulling LDL in the blood.

Some people can not tolerate statins due to effects such as muscle pain or weakness, memory problems or confusion, or even the development of diabetes in some people the other. For others, a statin alone may not be effective in controlling LDL, even when taken in high doses. In these circumstances, you need alternatives to statins to control LDL. 

Write IMPROVE-IT

Ten years ago, an international team of researchers led by Dr. Christopher P. Cannon, a cardiologist and professor of medicine at Harvard Medical School, began a trial called reduction improves outcomes: Vytorin Efficacy International Trial or improving IT for short. They recruited more than 18 000 men and women who are recovering from a heart attack. Half of the participants started taking a statin. The other half began taking a statin ezetimibe (Vytorin), a drug that lowers LDL cholesterol by blocking cholesterol absorption in the intestines.

After an average of six years, the statin-plus-ezetimibe group had an average LDL level of 54 milligrams per deciliter of blood (mg / dL) - well below what was once considered a "good" LDL - and 32.7% of the group had had a stroke or a heart attack recurrence. Those in the only statin group had a higher average level of LDL (70 mg / dl), and 34.7% of them had had another heart attack or stroke. Side effects are not high in the group of statins and ezetimibe statin alone group.

The difference in cardiovascular events between groups may seem low, but even a reduction of 2% spread in the population of the United States could make a significant breach of deaths and disability from cardiovascular diseases. 

What this means to you

All participants improve-IT started taking a statin or ezetimibe shortly after suffering a heart attack statins. As with any study, it is possible that the results are applicable to this group. But it also makes sense that the results would apply to large groups of people who have heart disease or at risk of it.For many years, the guidelines on the reduction of LDL cholesterol offered specific targets. They recommended that LDL levels be kept below 100 mg / dl, with an optional lens below 70 mg / dL. New guidelines launched in 2013 are no longer focused on the target levels.  

Instead, they recommend different intensities of LDL-lowering therapy according to the cardiovascular risk profile of a person. The higher the risk, the more intensive LDL-lowering therapy should be. The IMPROVE-IT experts findings may have to rethink that approach.  

Beyond statins

In the future, a new class of potent LDL-cholesterol agents, called PCSK9 inhibitors, can fundamentally change the way LDL was reduced in people with heart disease or at risk of it. Until then, ezetimibe and a statin can be a very good option taken. New research published today not only the documents that ezetimibe lowers LDL cholesterol, but also reduce the risk of heart attack or stroke. The new findings provide a strong rationale for the use of ezetimibe a statin alone is not enough.