Two drugs known to reduce cholesterol to all-time lows were found recently to have a different effect than hoped by their manufacturers. The drugs, evolocumab and alirocumab, were approved by the Food and Drug Administration in 2015 after being shown to significantly lower cholesterol, but without having been put through major clinical trials to test their effect on patient’s overall risk of heart disease or death.
The drugs, marketed as Repatha and Praulent, did, in fact reduce cholesterol in patients, sometimes to levels as low as 30 mg/dl. These lows have never been seen before with other cholesterol-lowering drugs or other medical interventions. Many medical professionals were excited about the ability for these medications to reduce cholesterol so significantly because naturally this reduction would then reduce the risk of heart attack and improve health outcomes.
Evolocumab manufacturers did their own testing to determine the drug’s impact on heart health and health outcomes. They published their results in the New England Journal of Medicine in March 2017. The study found that the drug did reduce the risk of heart attack and stroke, but only by about 15 percent. Neither drug was found to reduce a high cholesterol patient’s risk of death.
While the drugs’ cholesterol reducing abilities are a significant benefit to patients battling to keep their cholesterol in check, the hopes of the medical community that these drugs would greatly eliminate heart disease were dashed.
“Having high cholesterol is very hard on the heart, so reducing cholesterol is critical to protecting a patient’s overall health,” Dr. Michael Budler, M.D. said.
Budler is an interventional radiologist practicing in Grand Island, Nebraska. He treats patients with high cholesterol using angioplasty and vascular stenting methods.
Angioplasty is a procedure that uses a small catheter to insert a small balloon into arteries clogged with hardened cholesterol, a condition known as atherosclerosis. The balloon is gently inflated and pushed through the artery. As the balloon moved through the artery, cholesterol is pushed back against the arterial wall. This increases the flow of blood through the artery, reducing strain on the heart.
Vascular stenting is like the angioplasty procedure, but after the balloon is inserted wire mesh is pushed into the artery through the catheter. This mesh holds the cholesterol against the wall of the artery.
“Cholesterol reducing medications can and do help, but having high cholesterol over long periods of time does damage that no pill or drug can fix instantly,” Budler said.
Patients with high cholesterol should change their diets and avoid foods high in cholesterol and saturated fats. Increasing fiber and whole grain intake, eating healthy fats and foods rich in omega-3 fatty acids are ways to reduce bad cholesterol, also known as low-density lipoprotein or LDL cholesterol.
Avoiding trans fats, found in deep fried or processed foods, is another way patients can positively impact their cholesterol levels and their health.
People with high cholesterol should also add exercise to their daily routines. Thirty minutes of exercise per day help increase good cholesterol, known as high-density lipoprotein or HDL cholesterol. Suggested exercises for patients with high cholesterol include swimming, walking and bicycling.
“Patients with high cholesterol should consult their physician before beginning any exercise routine,” Budler said.
Exercise contributes to losing weight, which is known to reduce bad cholesterol levels.
“Losing just five to 10 percent of your body weight significantly helps lower your cholesterol,” Budler said.
Quitting smoking also will help raise good HDL cholesterol levels, as well as to lower blood pressure and reduce strain on the heart. Reducing alcohol consumption to moderate levels also lowers cholesterol levels. Moderate levels are two drinks or less per day for men, and one drink or less per day for women.
NPR, “Pricey New Cholesterol Drug’s Effect on Heart Disease is More Modest than Hoped”, 17 March 2017