Cholesterol-lowering statins are highly effective in reducing heart attacks and stroke. But they don’t work for everyone, and sometimes, they can cause intolerable side effects. For these patients in particular, PCSK9 inhibitors bring new hope.
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A new class of drugs, PCSK9 inhibitors lower levels of “bad” LDL cholesterol in a different way than statins. They have been shown to lower LDL 40 to 70 percent when used alone or combined with a statin or a statin plus ezetimibe (Zetia), a different cholesterol-lowering drug.
Two groups targeted
PCSK9 inhibitors may be used when:
- statins fail to lower LDL cholesterol levels to goal
- statins cause distressing muscle pain or weakness
- cholesterol levels are sky-high due heterozygous hypercholesterolemia, a genetic condition
PCSK9 inhibitors may not work in people with few, or poorly functioning, LDL receptors on their liver.
Unlike statins, which are daily pills, PCSK9 inhibitors are given by injection every two or four weeks.
On the path to approval
Current research is looking at the optimal dose, long-term safety and tolerability of PCSK9 inhibitors.
“So far, the drugs appear to be safe and effective at reducing LDL cholesterol. What remains to be shown is whether they will have an impact on reducing heart attack and heart-related death,” says Michael Rocco, MD, Medical Director of Cardiac Rehabilitation and Stress Testing in the Section of Preventive Cardiology.
“It’s still early in the testing process,” says Steven Nissen, MD, chairman of Cleveland Clinic’s Robert and Suzanne Tomsich Department of Cardiovascular Medicine, who calls PCSK9 inhibitors “promising.”
“If these drugs prove to be both safe and effective, virtually anybody will be able to reach their LDL-cholesterol target,” he says.