Summary
Abbott Laboratories' (ABT.N) Niaspan, though inexpensive and older, lowered HDL and shrunk artery diameter in heart patients more effectively and safely than Merck & Co's (MRK.N) moderately expensive Zetia.
Though there is little reason for doctors to prescribe Zetia now, there are real cautions about Niaspan that many people with liver concerns will appreciate. And so will their physicians.
An alternative and winning intervention, essentially unexplored by Pharma, is diet.
Analysis
"Halted early" is never a good sign for one company's drug, when it is being comapred to another.
Yet this study Abbott Laboratories' (ABT.N) Niaspan appeared to be so much more effective and safe than Merck & Co's (MRK.N) Zetia. In fact, Zetia has 5 times the serious side effects than did Zetia.
This study looked at people with or at high risk for heart disease with controlled LDL levels, but too low HDL. HDL is widely thought to be more important, in the long run, for protecting against heart attack.
Very cheap Niaspan was much better than moderately expensive Zetia (which is a combination of expensive Vytorin and cheap generic Zocor) at helping to raise HDL and not turn arteries into atherosclerosis.
So why won't doctors buy this? Not because Niaspan, at 2grams per day, can cause uncomfortable flushing, which is widely reported. Instead, because it can cause nausea, jaundice and elevated liver enzymes which mimic hepatitis, which is not. And natural or not, (and reversible though it may be), hepatitis like blood tests scare lots of people.
See my GLG Analysis "If Only Flushing Were the Only Problem, Abbott Would Have a Hit on its Hands"
Until then, doctors will be uncertain what to do: they certainly have no reason to prescribe Zetia, as it has not been proven to prevent cardiovascular or cerebrovascular events. Some may try Niaspan, as it shrunk arteries in this study, which is something that may be meaningful, and patients like to hear. And it's inexpensive and it's a B vitamin, albeit a proprietary form of one.
Or, patients may actually look towards diet more closely...something physicians are powerfully positioned to address, but have little training or time to address...at least one, by one. Indeed, the popular press and physician celebrities are already writing and speaking about how to lower cholesteroll with what you eat. Effectively.
