examination, Merck's lawyer attempted to get Sim to address other possible causes, asking him whether Humeston had suffered a plaque rupture at the time of the heart attack. A plaque rupture occurs when plaque breaks away from the artery wall and causes a blockage. Sim said that would be "total speculation," adding, "I am left in retrospect with a patient who had no, or minimal, coronary risk factors, who ... did not have coronary disease, who had a myocardial infarction, and who was on Vioxx. "If someone asks me did Vioxx play a contributing role, or did he have a plaque rupture for garden variety coronary disease, my tendency -- my strong feeling -- is that it would be unlikely he had a plaque rupture," Sim testified. Sim said since the heart attack, Humeston's heart suffers from diminished pumping efficiency. Another cardiologist, Dr. Nicholas De Pace, who reviewed Humeston's medical history, later took the stand and concurred with Sim. "He doesn't have any visible plaque of any significant degree," De Pace said. Asked by Humeston's attorney Christopher Seeger whether he regarded Vioxx as risk for heart attack De Pace replied, "I would add Vioxx to that list as a risk factor and a trigger factor. Vioxx increases the risk of a heart attack above the baseline. "You only have to take Vioxx for a short period of time," De Pace said. "It's a trigger." Merck contends that Humeston only took the drug intermittently for two months and that his age, weight and other medical factors led to his heart attack -- not Vioxx. Humeston charges that Merck long hid the risks of Vioxx in an effort to preserve sales of its multibillion-dollar drug -- a contention expected to resurface in thousands of pending Vioxx lawsuits. The drugmaker has said it pulled the arthritis drug from the market last September as soon as it had definitive evidence that long-term use doubled heart attack and stroke risks. The Atlantic City trial is being closely watched following Merck's defeat last month in Texas in the first Vioxx lawsuit to go to trial. In that case, a jury found Merck negligent in the death of a man who took Vioxx and awarded $253 million to his widow -- an award expected to be reduced and a verdict Merck has said it would appeal.
