The biggest trouble spot is that this trial design (placebo vs. a combination therapy of which one component is unproven) is a back door placebo-controlled secondary prevention trial with only a 22% RRR despite a 61% LDL reduction- this is underperformance if you (albeit cautiously) compare to other high risk populations studied with simva vs. placebo… 4S, HPS…. makes you wonder how much opportunity there is within IMPROVE IT to show that simva + ezetimibe is better than simva alone. So, the trial is strictly interpreted as negative by its primary endpoint, not surprising for the negative endpoint of AS, but hiddenly underperforming for the “positive” finding of the RRR vs. placebo. There is no reason to use combination simva + ezetimibe over simva alone based on this trial. Await further evidence.

What, precisely, are you saying is the “great news” we now have about Vytorin we didn’t have before.

Genuine question. My wife is taking it.

Especially after we discovered that ENHANCE had been criticized by influential MDs, who had not known that VYTORIN in ENHANCE performed as well as, or better, as Atorvastatin performed in the ASAP-extended, RADIANCE-1, and Cashmere studies, and better than Niacin-statin in ARBITER 2 study. We had so-called critics, who actually knew very little about FH patients and what was to be expected from CIMT. Clean (lacking lipid) arteries progress very slowly (fibrosis) as in ENHANCE. It has become an embarassment for the ACC, the Cleveland Clinic and Walter Reed Hospitals that carried on so poorly, harming so many patients, who were ultimately influenced to stop taking life saving lipid-lowering drugs.