A New Era Of Lipid Lowering Therapy Not Faraway

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A New Era Of Lipid Lowering Therapy Not Faraway
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Sumera B Reshi

Whenever we hear about Cholesterol, we all get goosebumps. What actually is Cholesterol? Cholesterol is a fat substance. LDL cholesterol brings about fatty deposits that can clog arteries. The plaque build-up causes atherosclerosis, which impedes blood flow through arteries in the heart, brain, kidney, and extremities. The body’s solution to this problem is to bind cholesterol to certain proteins that function as transport vehicles carrying different types of fats such as cholesterol, triglycerides (TG) and phospholipids.

 

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These combinations of fats and protein are termed lipoproteins. Low-density lipoprotein (LDL) is one of the body’s lipoproteins and an important carrier of cholesterol. The result can be carotid artery disease, peripheral artery disease, angina, chronic kidney disease, or coronary heart disease, the number one killer of Americans.

So is there any magic diet which can reduce LDL and keep the heart healthy? Till a few years back there was no solution, no tablet, no diet in sight which could have helped medicos and ailing heart patient’s a bit of relief. Thanks to medical innovations, there are certain few drug combinations which can help reduce LDL levels by 75 per cent.

Recent studies into the domain reveal that patients with ultra-low LDL from taking statins combined with a new class of cholesterol-lowering drugs (PCSK9 inhibitors) have a 20 per cent lower risk of cardiovascular death, myocardial infarction or stroke. The drug coded as PCSK9 inhibitors initiated a new era of lipid-lowering therapy. And certainly is a good news for millions of people who have high LDL and low HDL levels across the globe.

Undoubtedly, cholesterol problems are very common among South Asians due to genetic risk, lack of physical activity, and suboptimal dietary habits. The probability of dying from heart disease in young people doubles with every 40 points increase in total cholesterol. LDL and total cholesterol levels among Indians are similar to that of Caucasians but higher than other Asians, therefore, heart disease risk among South Asians is double than that of other ethnic groups.

Besides, South Asians tend to have low HDL (good cholesterol) levels which put them at obviously increased risk for heart disease. HDL is even more important than LDL. Low HDL is three times more common than high LDL in patients with premature heart disease. Centenarian (those lucky few who live to be a 100 years of age) often have very high HDL levels, which may account for their longevity.

What then is this new drug and how it works? The new drugs, called PCSK9 inhibitors, are monoclonal antibodies. They target and inactivate a specific protein in the liver. Knocking out this protein, called proprotein convertase subtilisin kexin 9, dramatically reduces the amount of harmful LDL cholesterol circulating in the bloodstream. Lower LDL translates into healthier arteries and fewer heart attacks, strokes, and other problems related to cholesterol-clogged arteries.

The magic drug was tested in three clinical trials presented at the annual meeting of the American College of Cardiology and simultaneously published in the New England Journal of Medicine. The trials suggest that an even better cholesterol-lowering medication may be on the horizon.

The trials show that PCSK9 inhibitors are extremely powerful cholesterol-lowering agents. In all three trials, all of the participants took a statin. Half got a PCSK9 inhibitor every two to four weeks; the other half got a placebo. After a year, LDL levels were 60 per cent lower in the PCSK9 groups.

However, low cholesterol is good only if it translates into better health. That was the case in the three trials. Participants taking the PCSK9 inhibitors were 50 per cent less at the risk of heart attack or stroke or develop heart failure over the course of the one-year trials.

On the contrary, this magic drug has few hitches. Neurocognitive problems, such as mental confusion or trouble paying attention, were seen in some of the study participants. As of now, PCSK9 inhibitors is given by injection every 2 to 4 weeks. PCSK9 inhibitors won’t be cheap. CVS officials have estimated that a year’s worth of treatment could cost between $7,000 and $12.000 and this amount is not within the reach of ordinary people, especially in South Asia.aw

But if the treatment is beyond the reach of a common man, then the best to try to lower it with a healthy diet like the Mediterranean diet and exercise. The combination of diet and exercise does the trick for some people. Others need help from medicine.

 

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