In the first discovery since statins were regularly used to lower cholesterol, a large, global study - in which doctors and heart patients in Singapore participated - has shown that a similar type of drug can protect people from heart attacks and strokes.
The benefits of Vytorin - whose active ingredient is made in a plant in Tuas and distributed for use worldwide - can help millions at high risk of heart attacks who cannot tolerate statins or do not respond to them sufficiently, according to a New York Times report on the findings.
Some had argued that statins reduced heart attack risk not just by lowering low-density lipoprotein (LDL) levels - the dangerous form of cholesterol - but also by reducing inflammation.
The new study indicates that the crucial factor is LDL, and the lower, the better.
The six-year study involved 18,000 people who had had heart attacks or episodes of chest pain so severe they went to a hospital. They were randomly assigned to take a statin or a combination of a statin and the alternative drug to further reduce LDL levels.
Both groups ended up with very low LDL levels - those taking the statin, simvastatin, had an average LDL of 69; and those taking simvastatin and the other drug, ezetimibe, or Zetia, in a combination pill sold as Vytorin, had an average LDL of 54.
Dr Daniel Yeo, the investigator for the study in Singapore when he was at Tan Tock Seng Hospital, said 75 patients here took part in it.
All were high-risk patients, with the majority having already had a heart attack. But all also had good LDL levels of less than 100.
The target for people with multiple risk factors and a previous heart attack is an LDL reading below 80.
Dr Yeo, now a cardiologist in private practice, was happy with the positive results of the study. "As doctors, we're always looking for new drugs to help patients."
Statins lower LDL by preventing it from being made. Ezetimibe lowers LDL by preventing cholesterol from being absorbed in the gut.
In those assigned to take Vytorin worldwide, there were 6.4 per cent fewer cardiac events - heart disease deaths, heart attacks, strokes, bypass operations and stent insertions.
That means, said Dr Christopher Cannon, a principal investigator and cardiologist at Brigham and Women's Hospital in the US, that two out of every 100 people who would have had a heart attack or stroke by taking the statin avoided those outcomes by taking the combination drug.
The study was sponsored by Merck, the maker of Vytorin, but the investigators had the right to publish what they wanted, with final say over what they wrote.
Thousands of patients suffering from high cholesterol levels in Singapore can benefit from a 50 per cent discount on this drug - which sells for roughly $3 a pill - under the MSD Assist scheme launched last year by pharmaceutical firm MSD Pharma (Singapore). MSD is a trade name of Merck.
The scheme lets Pioneer Generation and Community Health Assist Scheme cardholders pay only half the price for Vytorin and 23 other commonly used drugs.
Ms Lisa Yeoh, managing director of MSD Pharma (Singapore), said more than 2,000 people are currently enjoying the discount offered at more than 400 clinics.
Dr Yeo said that although he would prescribe Vytorin to high-risk patients, the first-line treatment would still be the use of statins.
In the United States, the study's results are making many wonder about the latest cholesterol guidelines, which did not mention any drug other than a statin.
"The guidelines didn't say they didn't believe in cholesterol, but they made it clear that the evidence is for a statin, not for any agent that lowers cholesterol," said Dr Eugene Braunwald, co-author of the study.
