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Cholesterol Control: PCSK9 Inhibitors vs. Statins



Nearly 74 million Americans have high cholesterol, according to the Centers for Disease Control and Prevention (CDC), but fewer than half are receiving treatment for it, putting them at a higher risk for heart attack and stroke.

When a new treatment comes along for a prevalent health problem like high cholesterol, the excitement can sometimes be more hype than fact. PCSK9 inhibitors are a new class of cholesterol-lowering drugs. Keep reading to find out how well they work, what potential risks they carry, and who can benefit from them.

Cholesterol Basics

There are two primary types of cholesterol: low-density lipoprotein (LDL) and high-density lipoprotein (HDL). LDL is also known as “bad cholesterol” because at high levels it can lead to plaque accumulating on your artery walls and possible heart attack or stroke.

HDL, on the other hand, is known as “good cholesterol.” High levels of this type of cholesterol can actually reduce the risk of heart attack and stroke. So, when we talk about someone needing medication for high cholesterol levels, we’re typically discussing LDL cholesterol.

What Statins Do

Statins are one of the most common pharmaceutical methods used to lower cholesterol. They work by blocking a substance that your liver needs to make cholesterol, and they help your body reabsorb any plaque that has formed on artery walls.

There are currently seven statins on the market:

  • atorvastatin (Lipitor)
  • fluvastatin (Lescol)
  • lovastatin (Mevacor)
  • pravastatin (Pravachol)
  • rosuvastatin (Crestor)
  • simvastatin (Zocor)

Common side effects include muscle and joint pain, nausea, and headaches. Other, more serious risks include:

  • liver damage
  • increased blood glucose levels
  • higher risk for type 2 diabetes
  • cognitive (mental) problems
  • muscle issues

What PCSK9 Inhibitors Do

PCSK9 inhibitors are new and two have just recently become available. In July 2015 the Food and Drug Administration (FDA) approved alirocumab (Praluent), marketed by Sanofi-Aventis and in August 2015 approved evolocumab (Repatha), a PCSK9 inhibitor from Amgen.

These drugs work differently than statins. They target a protein in the liver known as proprotein convertase subtilisin/kexin type 9 (PCSK9). By “knocking out” this protein, the drugs reduce cholesterol in the blood.

So far, many studies have suggested that they are effective. One showed that alirocumab reduced LDL levels by 61 percent, and also reduced the likelihood of cardiovascular events like heart attack and stroke. Another found similar results with evolocumab.

Interestingly, many of the studies looking at the effectiveness of PCSK9 inhibitors tested people who were also taking statins, suggesting that the drugs could be used together.

As with all medications, there are some disadvantages though. All of the PCSK9 inhibitors under consideration are injectable medications. Some patients reported side effects, like:

  • neurocognitive problems
  • runny nose and sneezing
  • upper respiratory tract infection
  • flu symptoms
  • back pain
  • redness, pain, itching, swelling, or bruising where the injection is given

Also, PCSK9 inhibitors are expensive. Treatment costs have been estimated around $14,000 per year.

The Takeaway

It’s likely that PCSK9 inhibitors will be used with statins when statins alone are insufficient, as well as by people who are statin intolerant.

If you’ve had issues managing your cholesterol levels, talk to your doctor about the possibility of using PCSK9 inhibitors.