New Drugs May Reduce Chances of Heart Attack or Stroke
Treatments for high cholesterol, and related problems such as heart attack or stroke, are constantly being refined. New drugs have been trialed in the US which lower cholesterol and have been shown to reduce the risk of these problems occurring significantly, compared to treatment with conventional drugs such as statins.
In safety and efficacy trials funded by drug manufacturer Amgen, 4,465 patients were selected at random to either receive the drug evolocumab alongside their standard care, or to receive only standard care involving a prescription of statins.
After one year, the rate of cardiovascular events – including heart attack, stroke, hospitalisation, surgery to open blocked arteries, and death – was shown to be 0.95% in the evolocumab group, compared to 2.18% in the group taking traditional statins.
“The reduction in LDL was profound and that may be why we saw a marked reduction in cardiovascular events so quickly,” said lead author Marc Sabatine, senior physician in the Division of Cardiovascular Medicine at Brigham and Women’s Hospital in Boston.
“It suggests that if we can drive a patient’s LDL cholesterol down a large amount to a very low level, we may start to see a benefit sooner than would be expected with a more modest intervention.”
The research was published in the New England Journal of Medicine, and presented at the American College of Cardiology annual conference in San Diego.
How the Drug Works
Evolocumab is part of a new class of drugs called PCSK9 inhibitors, which work differently from statins.
It is a human monoclonal antibody, which blocks the harmful protein PCSK9, stopping it from interfering with the liver’s capacity to remove cholesterol from the blood. As the liver can work better, this in turn lowers the blood’s levels of low-density lipoprotein, otherwise known as LDL or ‘bad cholesterol.’
Past research has shown evolocumab to lower LDL cholesterol by up to 61%
Potential Side Effects
At this stage, there is still some concern about potential side effects to these drugs, including concerns about their effect on thinking, memory and confusion.
Whilst these problems only affected 1-2% of patients, and may be temporary, they were twice as common as this among patients taking another of the new class of drugs. This will be monitored closely as trials on these drugs continue.
These drugs could be available in the US as soon as later this year, if they are approved following a review of the data by the FDA.
However, more years of study are planned to fully understand their effects. For instance, the figures from this initial study are uncertain, since the overall number of cardiovascular events was small – only 60 altogether. A long term study of 27,000 people planned for 2017 should give a more reliable and broader picture of the comparative effectiveness of these drugs.
If it is proven that they are significantly more effective than existing drugs, then this could provide a welcome alternative for those people who do not succeed in lowering their high cholesterol with diet, exercise, and the conventional statin drugs currently available.
One independent expert, Dr Judith Hochman of NYU Langone Medical Center, described these results as “really impressive and very encouraging.”