What's to stop juries from blaming Vioxx for strokes and heart attacks that would have occurred anyway?
Either the imaging technique doesn't predict whether drugs prevent heart attacks and strokes, or Zetia isn't going to prevent heart attacks and strokes, says Prediman K. Shah, a researcher who studies cholesterol at Cedars-Sinai Medical Center.
For instance, if doctors announced that eating 12 oranges a day would increase longevity and prevent strokes, heart attacks and all sorts of cancers, the price of oranges would soar until new groves were planted.
But both TNT and PROVE-IT lumped together strokes, heart attacks and cardiac deaths.
One could argue that these drugs have greatly improved the treatment of heart disease and are partially the reason why deaths due to heart attacks and strokes have slowed over the past decade.
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He also said the results "do not bode well" for larger studies that aim to prove Zetia and Vytorin prevent heart attacks, strokes and deaths better than other medicines.
His main argument on the pooled analyses is that the risk for heart attacks goes away if you look at heart attacks, strokes, deaths, and heart surgeries.
He is helping to head up a 10, 000-patient study comparing Vytorin and Zetia for preventing heart attacks, strokes and deaths, with results expected in 2011.
The researchers surveyed the study participants about their chocolate consumption (as well as the rest of their diet), and also tracked the heart attacks and strokes that occurred in the group.
The study, funded by Pfizer (nyse: PFE - news - people ) and called Treating New Targets, or TNT, showed that the top dose of Lipitor decreased the risk of heart attacks and strokes in people with stable heart disease, compared to the lowest dose of the same drug.
Ministers said that computer modelling shows that offering the checks to those aged 40 to 74 - approximately a third of the population - will save 2, 000 lives a year and prevent 9, 500 heart attacks and strokes.
First of all, the very sick patients needing immediate and extensive care, people with severe strokes, heart attacks, major trauma and so on.
Weight-loss stimulants speed up metabolism but can cause strokes, heart attacks and cardiovascular problems.
Health services must take the long term view and prevent the heart attacks, strokes, blindness and kidney damage that diabetes can cause.
They will still offer outpatient and diagnostic services such as physiotherapy and X-rays, but they would not be able to treat life-threatening conditions such as strokes, internal bleeding and heart attacks.
The paper backs up Graham's estimate, voiced in his Nov. 18 Senate testimony, that between 88, 000 and 138, 000 people may have had heart attacks and strokes caused by Merck 's (nyse: MRK - news - people ) withdrawn arthritis drug, Vioxx.
But this may be less encouraging than it seems, because if vorapaxar increased the number of strokes due to bleeding, that could balance out any benefit from reducing heart attacks and strokes.
Vytorin competes with statin drugs like Lipitor from Pfizer and Crestor from AstraZeneca, which have been shown to prevent heart attacks and strokes.
At one point, the paper was going to be published in The Lancet, but Graham says it was delayed due to conflicts with his bosses at the FDA. Graham on Monday morning said that the paper is not in press at this time, and underscored that his estimate of up to 138, 000 heart attacks and strokes has not changed.
Suppress the prostoglandins in platelets, therefore, and you suppress the formation of the sort of clots that trigger heart attacks and strokes.
He predicts "a significant dampening of enthusiasm" for Zetia and Vytorin until the companies have data to show whether they affect heart attacks and strokes.
Diabetes is on the rise and there is a fear that after years of progress in reducing heart attacks and strokes, that is about to be reversed.
The protein is thought to be a measure of inflammation in the arteries, and inflamed arteries are more likely to develop the clots that cause heart attacks and strokes.
Merck and Schering-Plough just made their study even bigger, delaying it a year to 2012 and making it so statistically powerful that it can detect whether Zetia reduces heart attacks and strokes by as little as 9%.
Cholesterol-drug Zocor loses patent protection next year, and the painkiller Vioxx was withdrawn in September because it increased the risk of heart attacks and strokes.
Tooth decay and gum disease are major public health problems, associated with poor digestion, heart attacks, strokes and cancers, stemming from inflammation and subsequent infections.
AstraZeneca 's (nyse: AZN - news - people ) Crestor began a big survival trial three years before, and it just finished early, proving that Vytorin's main rival does prevent heart attacks and strokes.
The company is running human studies containing more than 90, 000 patients to prove these medicines prevent heart attacks strokes and deaths.
The study compares Vytorin, a pill that combines Zetia and the older drug Zocor, with Zocor alone to see if the newer combination prevents heart attacks, strokes, and deaths.
FORBES: Merck's Big Vytorin Study Could Change Rules For New Cholesterol Drugs
Adding Zetia to Zocor, he said, might lower cholesterol levels without reducing heart attacks and strokes.
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