A novel cholesterol medication taken by injection, Praluent uses a new method to remove cholesterol when traditional statins are not able to achieve the desired level of cholesterol or when statins are not tolerated.
The exact patients who will benefit most from this medication are not clearcut at this time, but certainly patients who have known coronary artery disease or heart attacks and who have not been able to tolerate statin medications will be the first to use this medication and to benefit.
When it will be clinically available is uncertain at this time, but it will be within a few months.
Read more >>>HERE<<<<
And the drug insert >>>>HERE<<<<
Wee Willie Keeler of the Baltimore Orioles had it right…..when he said to ‘Hit’em where they ain’t’; and now the official advice from the US Department of Health is that cholesterol in the diet is not a problem.
Don’t get confused….cholesterol is still a concern, it’s just that most cholesterol (80+%) is made by your body, not ingested in foods. This means that egg yolks, and shellfish, which have gotten a bad rap for a lot of years due to the high amount of cholesterol they contain, are off the ‘NO EAT’ zone and can be consumed without concern. The amount that external cholesterol ingestion contributes to your cholesterol levels is modest, and thus there is no reason to avoid these foods.
But don’t mistake this recommendation with the thought that cholesterol is not considered a contributor to heart disease….it is. It’s just that the amount you get from exogenous sources is modest and need not be modified.
This is similar to salt in the diet. I have patients tell me all the time….”I never use the salt shaker….so don’t worry about my salt intake.” But the salt shaker only accounts for about 12% of your salt intake in the day. Salt is hidden in all packaged and cooked foods and that is where we find the vast majority of our salt. So…..our foods are ‘hitting them where they ain’t’…and we need to be smart and understand how these food factors come to play a role in our long-term health.
An injectable cholesterol medication, known as PCSK9 inhibitors, are emerging as an effective treatment for those who cannot tolerate statins like Lipitor, or who cannot achieve goal levels of cholesterol with standard medication.
A spate of new studies published at the American College of Cardiology meetings show that these forms of medication are safe, effective at reducing cholesterol 50+%, and are well-tolerated. In addition, some of the study information shows heart attack and stroke reductions, the endpoint most important in treatment of cholesterol.
These injections will be once a week or once a month, and will work via blockage of a protein involved in LDL (bad cholesterol) clearance. The anti-PCSK9 agents include Amgen’s evolocumab, alirocumab from Sanofi and Regeneron and Pfizer’s bococizumab.
Read more >>>>>>>HERE<<<<<<.
Statins (Lipitor, Crestor & others) are effective, safe, and have been shown to prevent heart attacks and strokes. Now, a new competitor is potentially coming to market, as it continues to show promise in lowering bad (LDL) cholesterol by 50-66%. This group of medications are called anti-PSCK9 agents & include Amgen’s evolocumab, alirocumab from Sanofi and Regeneron and Pfizer’s bococizumab.
These are injectible medications, they are showing promise and safety. Further studies will confirm if they prevent heart attacks and strokes, and if they do so, they will offer an alternative agent for patients with heart disease, and in particular will be available for those are are unable to tolerate statins due to muscle or liver issues.
Read more >>>>>HERE.
The latest guidelines for cholesterol treatment have been changed once again, and this time in good direction.
Rather than focusing on ‘goal numbers’ the the measure of success, the newest guidelines for cholesterol treatment take a more moderate approach, and focus on getting the ‘right’ people on medication and lowering their cholesterol effectively, if not massively. This NY Times article summarizes the latest concerns nicely.
Now, rather than focusing on guidelines and goal-numbers, we can use our statin medications (Lipitor, Pravachol, Zocor, Crestor) to gain reasonable cholesterol reductions knowing that the lion’s share of the benefits come with modest dosing and results. Yes…more can be better, but incrementally so. Pushing things to their limits is not necessarily more-and-more is better-and-better.
Like Twain noted…..”It’s not what you don’t know that gets you in trouble…it’s what you know for sure that just ain’t so.”
I hear from patients that they have concerns that statins (cholesterol lowering medication like Lipitor, Zocor, etc…) can cause memory loss and that they have read this in the paper. This question has been raised at times and the information is mixed.
On one hand, as a strong medication to prevent stroke, it is thought cholesterol-lowering medication should reduce cognitive decline by prevent strokes and microstrokes and thus preventing multiple brain injuries that could increase the likelihood of dementia.
On the other hand, cholesterol is an important component of all cells, and in particular the cells of the CNS (central nervous system….read brain) and by interfering with normal cholesterol production, they may cause unanticipated injury to these cells and impair memory.
Enter the latest ‘meta analysis’…a study of various studies, that shows no evidence of cognitive decline with statins. In a revew of 25 different studies, they found no issues of significant memory loss and this data is considered reassuring to those of us (myself included) on statin medication.
Although this is reassuring, more data will be forthcoming and we will keep an eye on this topic as it is of keen interest. For now, I think we can feel confident in the ongoing safety of these widely used medications.
The study in Annals of Internal Medicine
Statin medications have had a profound effect on heart disease across the world, but there are a variety of limitations with these medications including lack of effect, side effects, and inadequate results in patients at highest risk (inability to achieve ‘goal’ levels of cholesterol.)
Enter a new treatment, a medication that is a ‘biological agent’, an antibody that is directed against the production of cholesterol and appears to cause a profound reduction in cholesterol, up to 50% greater effect than the strongest statins. The medication appears generaly safe and is undergoing broad testing by a variety pharmaceutical firms that see billions of dollars in sales from this category of medication, particularly for patients with heart attacks and known heart disease.
The medication will require an injection, much like insulin, and will be given once or twice a week. All of this will depend on the outcome of ongoing research, but keep your eyes out for this information and we’ll keep you updated.
NY Times Article
Hi Dr. Lakin–
I’m forwarding this message because it speaks to an issue that has concerned me for some time. I have been working out consistently, lifting weights and stretching twice a week, walking or bicycling twice a week and doing yoga twice per week, for several years now, and have felt that I was not making much progress in terms of aerobic capacity and developing muscle mass. The research reported in the attached email suggests some reasons why that may be. When I meet with you in June, I would like to discuss how we might manage this situation, or whether we should even try.
From The New York Times:PHYS ED: Can Statins Cut the Benefits of Exercise?An important new study suggests that statins, the cholesterol-lowering medications that are the most prescribed drugs in the world, may block some of the fitness benefits of exercise, one of the surest ways to improve health.Statins and Exercise: NY Times
Interesting…and this is something I’ve wondered a bit, as I take a statin (very low dose) and that is does impair my physical capacity slightly. That said, my dad had bypass at 54…so I feel the need for some help (imperfect diet, and all). Certainly, the potential for insidious side effects of medications are something to consider, and this may be one of those cases.
As always, the balance of benefits and risks need to be considered on a case-by-case basis and individualized to the particular person.
We can revisit when we get together….thanks for sending.
More and more medications are being manufactured in India and these are produced safely and without concern.
This week, the LA TIMES reported that there is a recall of bottles of Lipitor 20 and 40mg tablets manufactured by Ranbaxy. The reason for recall is small particles of glass in the medications (which is a reason for recall, but unlikely to cause any harm).
If you have questions, ask your pharmacist the particulars about your prescription.
A large Danish study demonstrates a reduced cancer risk in people on statin medications like Lipitor. This good news should be interpreted with some caution as study does have some limitations, but the fact that the medication did not show an increase risk of cancer issues is great news for those millions of us on medication.
Statin medications are the ‘cell phones’ of the modern pharmacopia…..we just can’t live without them and they are a boon to our lives. If you are in need of cholesterol-lowering, using medications are effective and increasingly proven to be safe.