As the American College of Cardiology meeting nears this coming weekend in Chicago, the curtain raisers have begun to appear. Last week, Forbes set the stage by discussing why the full study results, which will be presented for the first time, are important. And this morning, The Wall Street Journal does a look back on how the controversial Enhance trial became controversial.

As the paper recounts, the Enhance trial found Vytorin was no better at modifying the thickness of neck arteries, a marker shown to correlate with the risk of heart attack and stroke, than Zocor. But docs and public officials questioned whether Merck and Schering-Plough delayed results for more than a year to protect billion of dollars in sales. The drugmakers, the paper writes, argue they were simply trying to correct irregular data. But by late 2005, company officials overseeing the study already had spotted a threat to Vytorin. They noticed, they now tell the Journal, that patients being studied were healthier than expected - which could make it harder to demonstrate Vytorin’s superiority at slowing disease.

“What we were trying to do was to improve…the precision and the accuracy of the data so that at the end, the results would be credible,” Enrico Veltri, Schering-Plough group vp of global clinical development and a leader of the joint venture, tells the Journal.

The Vytorin study has fueled two broad controversies - the handling of the trial has sharpened the debate over how much control sponsors should wield in clinical trials that influence docs and regulators. And the paper adds that the results have led some skeptical doctors to question the value of cholesterol-lowering drugs that have become the front-line medical weapon against heart disease.

The management of the Vytorin trial, known as Enhance, was unusual in a number of ways. The drugmakers previously acknowledged they kept the study under wraps for more than a year amid a prolonged effort to address their concerns about the data. They didn’t provide for an independent steering committee to oversee scientific issues, as is typically, though not always, done.

The companies brought in a second lab to compete to produce more accurate results than the original research team. In another unusual step, they proposed changing the primary way the data would be analyzed after it had already been collected. Company officials began publicly minimizing the significance of the study as too narrow. Finally, the companies compiled the results themselves, without the participation of the outside academic scientist they had hired to lead the study, and announced the findings in a news release in January, rather than wait for the researcher’s report.

For those who have followed the Vytorin saga, there isn’t much you don’t already know. For those of you who are unfamiliar with the details, the rest of the story will get you caught up. So take a look.*

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