VYTUL

This study is comparing two different approaches to lowering 'bad' cholesterol (LDL cholesterol) in people whose levels are too high despite already being on a common cholesterol medication called atorvastatin 40mg. The two options being compared are: switching to a combination pill called Vytorin (which contains two cholesterol-lowering drugs together) or increasing the dose of atorvastatin alone. The study aims to see which approach is more effective at bringing cholesterol down to safe target levels in people at high risk of heart disease. You may be eligible if: - You are 18 years of age or older - You have been taking atorvastatin 40mg daily for at least 3 months - You have existing coronary heart disease with cholesterol above 4.0 mmol/L, OR you have diabetes with cholesterol above certain levels - You are otherwise in good health with no significant other diseases You may NOT be eligible if: - Your diabetes is uncontrolled (HbA1c above 9%) - You have elevated liver enzymes or creatine kinase (muscle enzyme) in blood tests - You have high triglycerides (blood fat) above 4.5 mmol/L - You have significant kidney problems - You have a drug or alcohol dependency in the last 6 months - You are pregnant, breastfeeding, or a woman of childbearing age not using reliable contraception - You have taken certain medications such as fibrates, niacin, or antifungals in the past 5 weeks Talk to your doctor about whether this trial might be right for you.