NICE issues final appraisal determination on ezetimibe for hypercholesterolemia

http://www.nelm.nhs.uk:80/Record%20Viewing/viewRecord.aspx?id=585023

In this article there is a link to the NICE report. The report
mentions a 2005 meta-analysis of lipid-lowering therapies that
supposedly found no difference between statins and non-statin
therapies in the effect on CVD events. From this, the report
concludes that ezetimibe should reduce CVD events as much as statins
to the extent it lowers LDL by the same amount. I am not familiar
with this meta-analysis (they don't cite it), but both the meta-
analysis and the conclusion they draw from it seem highly
questionable. If there are no trials of ezetimibe with clinical
endpoints, I don't see how any meta-analysis of statins vs. other
lipid-lowering methods (e.g., diet, bile acid sequestrants, surgery,
etc.) can get around that fact. Even assuming that a 10% lowering of
LDL achieved through, say, diet had the same effect as a 10% lowering
by a statin, that says nothing about a 10% lowering by ezetimibe.

I don't disagree with using ezetimibe in certain limited situations.

Marilyn

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