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Survey Respondents Agree That Treatment through Dual Inhibition of Two Sources of Cholesterol is More Effective than a Statin Alone

MUNICH, GERMANY, Sunday, 29 AUG 2004 – Ninety-five percent of cardiologists agree that it is increasingly important to reduce LDL (“bad”) cholesterol levels lower than previously thought, in patients with risk factors such as diabetes or coronary heart disease, according to results from a new survey conducted in five European countries.1
The findings, released here today at the European Society of Cardiology Congress, also show that more than eight out of ten cardiologists (84 percent) surveyed agree that the new approach to cholesterol treatment, Dual Inhibition of two sources of cholesterol, is likely to achieve greater reductions in LDL cholesterol than just treating cholesterol produced in the liver. Dual Inhibition is the co-administration of a cholesterol absorption inhibitor, which inhibits absorption of cholesterol in the intestine, together with a statin, which reduces production of cholesterol in the liver; thereby resulting in significantly greater efficacy.
Commenting upon the survey results, Professor Elisabeth Steinhagen-Thiessen, Professor of Internal Medicine, Interdisziplinaeres Stoffwechsel, Centrum Charite, Universitaetsmedizin, Berlin, Germany says, “These findings reflect cardiologists’ understanding of the need to lower LDL cholesterol levels beyond current guidelines for patients with risk factors, and show an awareness of the increasing body of clinical evidence supporting the superior efficacy benefits of Dual Inhibition for LDL cholesterol treatment. This survey demonstrates that cardiologists recognize that early use of a cholesterol absorption inhibitor co-administered together with a statin is an important advance in cholesterol management.”
Cholesterol in the body originates from two main sources: production by hepatic and extra hepatic tissues and absorption in the intestine. Cholesterol-lowering agents (statins) reduce cholesterol levels by single inhibition, that is, by inhibiting the synthesis (production) of cholesterol in the liver. Ezetimibe, the first cholesterol absorption inhibitor, works by inhibiting intestinal absorption of cholesterol, both dietary and the cholesterol which is a component of bile. Ezetimibe/simvastatin provides Dual Inhibition by targeting both of the main sources of cholesterol in the body, production and absorption, providing significantly more effective reduction of LDL-C plasma levels.

Belief in more aggressive approach to cholesterol-lowering goals

The strength of cardiologists’ belief in getting LDL cholesterol levels lower was shown in their attitudes to self and family members’ treatment. More than half of respondents (55 percent) would try to reduce LDL cholesterol levels below guideline levels, if they were treating themselves or a close family member with risk of cardiovascular disease and high LDL cholesterol levels.
The new survey also reveals that more than half of the cardiologists surveyed (54 percent) agree in principle with reducing LDL cholesterol levels below guideline levels and/or lower than previously thought, and in practice would do this if treating themselves or a close family member with risk of cardiovascular disease and high LDL cholesterol levels.

Need for new cholesterol treatment paradigm

More than three quarters of cardiologists surveyed (78 percent) agree that co-administration of a cholesterol absorption inhibitor together with a statin (Dual Inhibition) helps more patients achieve lower LDL cholesterol levels than treatment with a statin alone.
In addition, more than two thirds of respondents (68 percent) say they would consider using a cholesterol absorption inhibitor with current statin treatment if they or a close family member had an LDL cholesterol level of 3.2 mmol/L and one or two cardiovascular risk factors.
More than half of respondents (59 percent) think that the co-administration of a cholesterol absorption inhibitor with a statin will help patients achieve lower LDL cholesterol levels more than a statin alone and would use Dual Inhibition therapy if they or a close family member had LDL cholesterol of 3.2 mmol/L, were on statin therapy and had one or two cardiovascular risk factors.
“It is encouraging that such a high proportion of experts are convinced by the increasing amount of clinical evidence in the public domain showing the need for patient treatment to lower cholesterol targets. Merck/Schering-Plough remains committed to the ongoing development of our cholesterol absorption inhibitor, ezetimibe, and the single tablet of ezetimibe/simvastatin, which provides Dual Inhibition. These medicines clearly help meet the need for new and more effective approaches to the management of high LDL cholesterol,” commented Dr. Chris Allen, Executive Medical Director with the Merck/Schering-Plough Pharmaceutical partnership.

About Merck
Merck & Co., Inc., which operates in many countries as Merck Sharp & Dohme, is a global research-driven pharmaceutical products company. Merck discovers, develops, manufactures and markets a broad range of innovative products to improve human health, directly or through its joint ventures.

About Schering-Plough
Schering-Plough Corporation is a global science-based health care company with leading prescription, consumer and animal health products. Through internal research and collaborations with partners, Schering-Plough discovers, develops, manufactures and markets advanced drug therapies to meet important medical needs. Schering-Plough’s vision is to earn the trust of the physicians, patients and customers served by its more than 30,000 people around the world.

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Notes to editor

Survey methodology
A total of 379 senior cardiologists from 5 European countries were telephone interviewed during July 2004 for the survey.

Senior cardiologists across Europe (UK, Netherlands, Germany, Switzerland and Spain) were recruited using online and published databases. A sample of 75 cardiologists was interviewed from each country. Each cardiologist was interviewed in their local language via telephone for 10 minutes.

References
1. European cardiologists’ views on cholesterol management and treatment survey. Conducted in July 2004 by Wirthlin Europe.

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