US heart group endorses statin-first approach

CHICAGO, April 1 (Reuters) - Patients having trouble controlling their cholesterol levels should first try stronger doses of statin drugs before trying Vytorin, the American College of Cardiology said on Tuesday, after studies questioned the newer drug's value.

A study released over the weekend reinforced earlier findings that Vytorin, made by Merck & Co (MRK.N: Quote, Profile, Research) and Schering-Plough Corp <SGP.N, worked no better than an older, cheaper statin in reversing the progression of heart disease.

The group representing heart specialists said results of the study should be considered as the government updates its national treatment guidelines.

The ACC sent its recommendation in a letter to the Senate Finance Committee's senior Republican, Charles Grassley of Iowa. He had criticized the group's initial response to negative news about Vytorin that suggested patients continue taking the drug and consult their doctors.

Full results of the study known as Enhance, released on Sunday, mirrored results in January that found the combination drug failed to show it worked any better than a cheaper generic statin at reducing the thickness of artery walls in patients with an inherited form of heart disease.

Vytorin combines the statin Zocor, known generically as simvastatin, with another cholesterol medicine, Zetia or ezetimibe, and is marketed by a joint venture of Merck and Schering-Plough.

Given the lack of evidence of a benefit, an ACC expert panel recommended on Sunday that doctors first put patients on a high-dose statin, and then try other drugs before reaching for Vytorin or Zetia.

"The study reinforces the need to adhere to current American College of Cardiology/American Heart Association Guidelines, which recommend statins to the maximally tolerated dose or to goal as first-line treatment for patients with coronary artery disease," the ACC said in its official response to the Enhance trial.

"The data from the Enhance study should be considered as the NHLBI (National Heart, Lung, and Blood Institute) guidelines writing group is working on their update of the national cholesterol treatment guidelines in the coming months," the group said. (Editing by Maggie Fox and Vicki Allen)