2023-05-10 14:41:00
A new drug helps lower dangerously high cholesterol. The Munich heart professor Volker Klauss explains the injection against heart attacks and strokes.
Munich – Millions of people are struggling with high cholesterol levels. A maximum of 30 percent of the cholesterol level can be lowered through diet, and regular exercise can also help. Those affected often have to take additional medication – especially if they have vascular diseases such as coronary heart disease or an inherited dyslipidemia; in the latter case, doctors speak of familial hypercholesterolemia.
Counteract high cholesterol levels: Inclisiran – The “syringe against heart attacks”
So far, most cholesterol patients swallow so-called statins. “They are practically the basic medication for high cholesterol levels,” explains Munich heart specialist Professor Volker Klauss (cardiology downtown). In recent years, however, other cholesterol-lowering drugs have come onto the market. Most recently, the drug Inclisiran received particular attention in specialist circles. It belongs to a group of drugs called PCSK9 inhibitors and is given as an injection under the skin. That is why it is sometimes referred to in the media as the “injection against heart attacks”. “Ultimately, these PCSK9 inhibitors ensure that the liver can absorb and break down more harmful LDL cholesterol,” explains Klauss.
The big advantage of Inclisiran: In contrast to other PCSK9 inhibitors such as evolocumab and alirocumab, it does not have to be injected every two or four weeks. Instead, the injection is repeated once after three months and is then only necessary every six months. According to previous study results, Inclisiran is able to reduce LDL cholesterol by half and thus reduce the risk of developing arteriosclerosis by 60 to 90 percent, reports the German Heart Foundation
Inclisiran injections need to be used less frequently than other cholesterol medications
High-risk patients in particular can benefit massively from this effect. The medical background: Elevated cholesterol levels should not be taken lightly. They are among the greatest risk factors for stroke and heart attack, especially in old age – especially in combination with other stress factors such as smoking, too much alcohol, obesity, diabetes and high blood pressure. Therefore, the cholesterol levels should be determined for everyone so that high-risk patients can be identified and treated at an early stage. “This also includes the one-time determination of the so-called lipoprotein (a), another factor from the lipid metabolism that can cause vascular diseases,” explains Klauss.
Cholesterol is produced in the liver and absorbed through food. It is needed as an important building block for the body’s cells and plays – in moderation – a role in the formation of bile acid and in the production of important hormones. “So that the cholesterol can be transported into the body via the individual blood vessels, the body packs the fats in protein packets and forms lipoproteins, consisting of fat (lipid) and protein (protein): LDL cholesterol and HDL cholesterol,” explains the foundation German stroke aid the background.
LDL cholesterol fuels vascular diseases – drug is said to protect against heart attacks and strokes
In particular LDL cholesterol (low density lipoprotein) can accumulate in the vessel walls and thereby fuel the insidious process of vascular calcification, which is known in technical terms as arteriosclerosis. “The arteries become more and more brittle or stiff and narrow,” explains cardiologist Klauss. “In the worst case, the blood vessel closes completely, downstream tissue can no longer be supplied with oxygen – and the dreaded meltdown in the heart or brain occurs, for example.”
In Germany, almost 200,000 people suffer a heart attack and almost 270,000 a stroke every year. Many victims die or remain permanently dependent on outside help after the illness. According to a survey by the renowned Mayo Clinic in the USA, almost three million deaths worldwide are linked to high LDL cholesterol levels. In addition to an unhealthy lifestyle and poor diet, the cause of elevated cholesterol levels can also, as already mentioned, be a hereditary predisposition (familial hypercholesterolemia). “Various diseases, such as diabetes or impaired kidney function, can potentiate the negative effects of high cholesterol levels,” Klauss knows.
Study on cholesterol-lowering drugs: statins are well tolerated if the dose is right
In order to get the risk factor cholesterol under control, drugs have been used successfully for a long time – above all statins. “They have been available since 1987 and serve as basic medication for high cholesterol levels,” reports Klauss. According to the long-time scientist, statins have been well researched. The good tolerability was only recently confirmed again in a large study that was published in the renowned journal The Lancet. According to this, only 1 in 15 patients treated with statins had side effects that were caused by statin therapy.
There are also rumors about statins that they often cause serious side effects or can even cause serious illnesses – for example Alzheimer’s dementia. But these claims have been refuted by studies, including an Australian research paper from the University of South Wales. On the other hand, it is undisputed that muscle problems can occur when statins are taken, especially in high doses. “However, these problems can usually be avoided by carefully adjusting the medication. Above all, it is important to carefully approach the optimal dose at the beginning of therapy,” advises Munich heart specialist Klauss.
Lower cholesterol with statins – Can also be combined
When statins alone are not enough to lower cholesterol levels, they are often combined with ezetimibe – a drug that reduces the absorption of cholesterol from the gut. Another variant that is often prescribed is the combination of ezetimibe and bempedoic acid. The latter inhibits – similar to statins – cholesterol absorption in the liver, but is said to cause less muscle pain.
The experienced cardiologist Klauss sees the newer drugs in the form of injections as a good addition to the therapy options. “They are particularly useful for patients for whom the tablets do not bring the desired success.” However, Klauss continues, injection therapy alone will not usually be sufficient for most patients. “A combination will almost always be necessary.” (Andreas Beez)
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