THESE drugs are an alternative to statins to treat high cholesterol and reduce the risk of heart disease, heart attack and stroke.
They work by inactivating a protein in the liver called proprotein convertase subtilisin kexin 9 (PCSK9) to reduce ‘bad’ LDL cholesterol levels in the blood. Rather than daily tablets as with statins, they are injected once every two to four weeks.
Studies show evolocumab and alirocumab lower cholesterol levels in the blood by more than half. They also don’t cause the side-effects associated with statins, such as muscle and joint pain – although long-term studies are needed as they reduce cholesterol to much lower levels than statins. The medicines were approved in 2016 but they are expensive, costing an estimated £4,000 per patient per year, compared with £12 a year for some statins. As a result, their use is often restricted to patients most at risk, such as those with familial hypercholesterolemia, a genetic condition that causes dangerously high cholesterol levels.
‘Both drugs have been shown to improve outcomes in patients with cardiovascular disease,’ says Dr Andrew Chapman, a clinical lecturer in cardiology at the University of Edinburgh.
‘For example, in a large trial of evolocumab, “bad” cholesterol levels fell by 59 per cent, and future cardiovascular events [such as heart attack] were reduced by 15 per cent.
‘Although expensive, if these drugs reduce future risk and therefore use of other resources within the NHS, this may be justified.’
