Written by Joyce Oenshao, as told to Kelly Wigginton
Current cholesterol treatment is focused on finding ways to combine current cholesterol medications in slightly different ways and target treatment based on the patient. It’s not just standardized, it’s getting everyone on statins right away. New research is targeting things like which treatments are better for older people and which treatments are better for cancer patients.
There is a new drug called Necletol, which is used for those most at risk. It’s people who have genetic or familial high cholesterol, or who have heart disease and need to lower their cholesterol further. It is called bempedoic acid. It has the effect of lowering cholesterol produced in the liver.
Statins are different in that they lower cholesterol in the blood by reducing the liver’s ability to produce cholesterol. This allows the liver to accept more cholesterol from the blood, lowering cholesterol levels. These can lower low-density lipoproteins (LDL) through HMG receptors. This is an enzyme that processes cholesterol in the body. However, necretol actually also inhibits cholesterol production in the liver through another enzyme on a pathway known as the ACL pathway.
Other drugs that have emerged in the past few years include PCSK9 inhibitors. These are great because they work to lower cholesterol in a completely different way than statins. It won’t cause muscle pain. Also, it is not necessarily toxic to the liver.
The only problem with PCSK9 inhibitors is that they are injectable. Luckily, it doesn’t really happen that often, as you only get an injection every two weeks. We’ve been using it more in people who have difficulty controlling LDL.
It is also very suitable for people with familial hypercholesterolemia. This is a genetic disorder in which the body does not properly recycle LDL cholesterol, so blood levels remain high unless treated. FH occurs when there is a mutation in one of several genes in the body. In most cases, it is the LDL receptor gene that helps find and remove cholesterol from the body.
Necletol is also a good starting point before starting LDL apheresis (when your doctor filters your blood to remove LDL cholesterol).
Another new option is actually statins. It is called pitavastatin or Livalo. It has the same LDL and total cholesterol lowering properties as all other statins, but somehow does not cause muscle pain. Many people have had greater success with this than other statins. Lower your LDL to where it needs to be.
In most cases, you can lower your bad cholesterol by about 20 to 30 points with proper lifestyle modifications, including diet and exercise. If you continue to make these good lifestyle choices, you can often reduce your statin to its lowest dose.
And I’ve seen some people who were able to get off their cholesterol medication completely.
A lot of times I ask people to change their lifestyle and they say: “Doctor, you know I’m not going to exercise.” Then we’ll talk about those risk factors. I said, “Okay, unless you’re going to change your lifestyle, at this point you need to be put on medication to lower your cardiovascular risk for stroke, myocardial infarction, and other health problems.” Is called. If you do it right, you can have an honest conversation with people to determine what is the best option for them.