2 better than 1?

There is enough evidence to suggest that lowering LDL cholesterol helps decrease the incidence of coronary artery disease. It is a bit of a surprise therefore to learn from the ENHANCE trial that a greater degree of LDL cholesterol lowering with the combination of Ezetimibe and Simvastatin, when compared to Simvastatin alone, did not have any significant impact on the carotid intima-media thickness.

The IMPROVE IT trial is now underway to study if this combination of Ezetimibe and Simvastatin will be better than Simvastatin alone in reducing cardiovascular events.

For now, there is no evidence to recommend that the combination of ezetimibe plus simvastatin is better than a statin alone for patients with elevated LDL cholesterol levels.

Note:
Exetimibe is a drug that lowers LDL cholesterol by reducing intestinal absorption of cholesterol.

Simvastatin is a drug that lowers LDL cholesterol by affecting a key enzyme in the liver.

Carotid intima-media thickness is a marker of atherosclerosis in the carotid artery.

Rosiglitazone, from Hero to Zero.

In the years that followed the launch of rosiglitazone, there were many papers on its usefulness for patients with diabetes. There were papers that showed the drug’s effectiveness in reducing blood sugar when used alone example and also when used in combination with sulphonylureas example or metformin example . Some other notable trials that showed beneficial effects of rosiglitazone were the DREAM trial and the ADOPT trial. In the DREAM trial investigators showed that rosiglitazone could reduce the development of diabetes in those who had impaired fasting glucose or impaired glucose tolerance while the ADOPT trial showed that rosiglitazone was better than metformin or a sulphonylurea in maintaining glycemic control as monotherapy.

Problems with the drug began to surface in 2007. In early 2007, the first reports that rosiglitazone was associated with osteoporosis and an increased fracture risk appeared - See here. Then, in June 2007 a meta analysis published in the New England Journal of Medicine showed that patients on rosiglitazone had a greater risk of suffering a myocardial infarction - (Read the article).