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After ENHANCE: the cholesterol hypothesis is alive and well

Ian R Hamilton-Craig
Med J Aust 2008; 189 (6): . || doi: 10.5694/j.1326-5377.2008.tb02045.x
Published online: 15 September 2008

Trials measuring major cardiovascular events as an endpoint are the best evidence to determine if an intervention such as ezetimibe conveys benefit

At an American College of Cardiology meeting in Chicago earlier this year, the long-awaited results of the Ezetimibe and Simvastatin in Hypercholesterolemia Enhances Atherosclerosis Regression (ENHANCE) trial were finally presented, with simultaneous publication in the New England Journal of Medicine.1


  • School of Medicine, Griffith University, Gold Coast, QLD.



Competing interests:

Ian Hamilton-Craig has received financial support to attend and give presentations at scientific meetings from AstraZeneca, Merck Sharp & Dohme, Schering-Plough, Pfizer, Bristol-Myers Squibb, Solvay, Sanofi-Aventis, Novartis and Abbott (Australia). He is a member of the Lipid Advisory Board of Merck Sharp & Dohme/Schering-Plough, AstraZeneca and Solvay, the Familial Hypercholesterolaemia Committee of the Australian Atherosclerosis Society, and the Council on Genetic Cardiovascular Diseases of the Cardiac Society of Australia and New Zealand.

  • 1. Kastelein JJ, Akdim F, Stroes ES, et al; ENHANCE Investigators. Simvastatin with or without ezetimibe in familial hypercholesterolemia. N Engl J Med 2008; 358: 1431-1443.
  • 2. O’Riordan M. ENHANCE published, presented, discussed, and debated: experts mull over what the findings mean. heartwire 2008; 30 Mar. http://www.theheart.org/article/851409.do (accessed Apr 2008).
  • 3. O’Riordan M. Congressional investigation into ENHANCE focusing on re-created expert panel minutes. heartwire 2008; 14 Apr. http://www.theheart.org/article/857431.do (accessed Jun 2008).
  • 4. Howard BV, Roman MJ, Devereux RB, et al. Effect of lower targets for blood pressure and LDL cholesterol on atherosclerosis in diabetes: the SANDS randomized trial. JAMA 2008; 299: 1678-1689.
  • 5. Kastelein JJ, de Groot E. Ultrasound imaging techniques for the evaluation of cardiovascular therapies. Eur Heart J 2008; 29: 849-858.
  • 6. van Wissen S, Smilde TJ, Trip MD, et al. Long-term safety and efficacy of high-dose atorvastatin treatment in patients with familial hypercholesterolemia. Am J Cardiol 2005; 95: 264-266.
  • 7. Jackevicius CA, Tu JV, Ross JS, et al. Use of ezetimibe in the United States and Canada. N Engl J Med 2008; 358: 1819-1828. doi: 10.1056/NEJMsa0801461.
  • 8. Kastelein JJ, van Leuven SI, Burgess L, et al. Effect of torcetrapib on carotid atherosclerosis in familial hypercholesterolemia. N Engl J Med 2007; 356: 1620-1630.
  • 9. Barter PJ, Caulfield M, Eriksson M, et al; ILLUMINATE Investigators. Effects of torcetrapib in patients at high risk for coronary events. N Engl J Med 2007; 357: 2109-2122.
  • 10. Brown BG, Taylor AJ. Does ENHANCE diminish confidence in lowering LDL or in ezetimibe? N Engl J Med 2008; 358: 1504-1507.

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