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Continued Vytorin use should be OK

Question: After reading about problems with Vytorin, is it safe to take, or is it true that this drug might cause a stroke?

Answer: The media blitz ­surrounding a recent clinical study has generated much misinformation. There was no evidence that Vytorin causes strokes or is unsafe. The ­clinical study compared Vytorin to Zocor. Vytorin is a combination product containing simvastatin and ezetimibe. Zocor contains simvastatin alone. (Ezetimibe alone is available as Zetia.)

Simvastatin and ezetimibe lower cholesterol in different ways. The combination lowers cholesterol more than either drug alone. Researchers wanted to find out whether the simvastatin-ezetimibe combination worked better than simvastatin alone in slowing artery-clogging plaque buildup.

It might seem like a no-brainer: The product that lowers cholesterol the most should be better at ­preventing plaque. The result: Vytorin didn't work any better than Zocor on plaque.

That raised some eyebrows.

Lost in the media hoopla, ­however, is that study participants had a genetic disorder that leads to very high cholesterol levels. (It's called heterozygous familial hypercholesterolemia.) So these results don't necessarily apply to other ­people. Additionally, the study ­focused on arterial plaque, a ­”marker“ for complications such as heart attack and stroke. Other studies are under way to evaluate the latter outcomes.

It should be noted that LDL cholesterol (the bad kind) was cut by 58 percent in the Vytorin group compared to 41 percent in the Zocor group. Drug-related adverse effects were similar in both groups. Based on these preliminary findings, there's no reason to stop taking Vytorin (simvastatin-ezetimibe) or Zetia (ezetimibe).

Q: I take a mix of soluble and ­insoluble fiber, along with plant sterols and stanols, vitamins and minerals, aspirin and glucosamine/chondroitin. Are there any problems with absorption of these nutrients and medications if they are taken at the same time?

A: As a precaution, I'd ­suggest separating the times you ingest the fiber, plant sterols and stanols with the other items by two to three hours. Fiber can interfere with the absorption of aspirin as well as calcium and possibly other minerals. Adding more fiber to your diet is a good idea. Most plant-derived foods contain soluble and insoluble fiber. Both improve bowel function.

Beyond that, soluble fiber can reduce blood cholesterol and might help lower or ­stabilize blood sugar levels. It's found in oat bran, ­oatmeal, rice bran, peas, beans, citrus fruits, ­strawberries, apple pulp, barley, psyllium, guar gum and pectin.

Insoluble fiber is found in grains and grain products, and fruits and vegetables such as carrots, cabbage, beets, brussels sprouts, turnips, cauliflower and apple skin.

Plant-derived stanols and sterols reduce absorption of cholesterol and add to the cholesterol-lowering effects of soluble fiber. These substances are now added to some ­margarines and other foods.

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