Letters To The Editor

The ENHANCE trial

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To the Editor: I read with great interest Dr. Davidson’s commentary article1 about the Ezetimibe and Simvastatin in Hypercholesterolemia Enhances Atherosclerosis Regression (ENHANCE) trial.2 However, his conclusion that ezetimibe (Zetia) still has a role as an add-on to statin therapy for patients who have not achieved their low-density lipoprotein cholesterol (LDL-C) target is of great concern to me and my patients. Based on this trial, I have taken many of my patients off of ezetimibe and have wondered if this is the right decision. I also have several physician patients who have told me that ezetimibe causes muscle cramping and other symptoms often found in patients who cannot tolerate statins, and in fact one of these patients was found to have congenital cirrhosis of the liver.

Ezetimibe is mainly active in the GI tract. What relationship does this medication have in those patients who have liver disease, ie, cirrhosis? Is it safe to give ezetimibe to patients who cannot take statins? I doubt it.

Consequently, I agree with Dr. Taylor’s editorial,3 which in essence states unless you are in a clinical trial, beware of ezetimibe!

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