The latest JAMA Medical News and Perspectives article looks at ezetimibe, approved by FDA in 2002 based on its ability to reduce LDL-C levels (a surrogate marker for prevention of cardiovascular disease) but without assessing clinical outcomes such as incidence of myocardial infarction, stroke or death. The 2008 ENHANCE trial from New England Journal of Medicine showed that addition of ezetimibe did not reduce atherosclerosis progression compared with simvastatin alone, despite lowering LDL-C levels. The latest cholesterol management guidelines, issued late last year by the American College of Cardiology and the American Heart Association, have moved away from reaching a target level for LDL-C. Similarly, future guidelines may abandon the use of ezetimibe and simply “treating the number”. How often do you see patients with ezetimibe prescriptions? What would you recommend or counsel them after learning this?
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