New WOW Medications for Cholesterol Management

When I presented the results of studies we conducted here at National Clinical Research about a new group of cholesterol lowering medications at the Scientific Session of the American College of Cardiologists in 2013 everyone said the same thing to me ... "WOW". This is why I have call them the WOW medications. Actually, these medications are called anti-PCSK9, but let's not get bogged down with this funny sounding name. Let me tell you their story so you can also say "WOW".

To understand why there is such interest in these medications you must first understand something about cholesterol levels in the blood. We have learned that the higher the level of blood cholesterol in an individual, the greater the chance a person has of experiencing a heart attack or stroke if left untreated. So, if a person's cholesterol level is 50% higher than average, then that person has a 50% high risk of having a heart attack or stroke in the next 10 years. This is why doctors check blood tests to see if their patients' cholesterol level is high so that they can discuss steps to lower that risk.

The next thing you need to understand is that simply lowering blood cholesterol levels will proportionately lower the chance of having a heart attack and stroke. There really is no magic to it. By depriving the body of some cholesterol in the blood stream means that there is less chance of it accumulating in the blood vessels and eventually causing heart attacks and strokes. The key word in the first sentence of this paragraph is proportional. This means that a reduction of blood cholesterol levels of 50% would be expected to reduce the risk of having a heart attack or stroke by 50%.

The best way we currently have of lowering blood cholesterol levels is with a statin medication (such as Zocor, Lipitor, or Crestor). As a group, statins can reduce cholesterol levels by 25 to 55%, depending on the statin and the dose used. So the best we can do with a statin medication is to lower cholesterol levels about 50%. Therefore the best we can lower the risk of a heart attack and stroke is about 50%. Half of the patients who take these medications benefit but the other half still have a heart attack or stroke in spite of faithfully taking their medication.

This is where the WOW medication comes in. These medications work in concert with the statin medication (through similar mechanisms) and lower cholesterol levels an additional 50-60% on average. To illustrate, if a patient has a cholesterol level of 200, and achieved a 50% reduction in their cholesterol level with one of the more effective statin medications, the patient would be left with a level of 100. If one of the new anti-PCSK9 medication was added to the statin, the cholesterol level would be lowered an additional 50% to a new cholesterol level of 50. All together, the statin plus anti-PCSK9 combination would have reduced the patient's cholesterol level by 75%, i.e. from 200 to 50. And that means the individual's risk of a heart attack or stroke is 75% lower. For patients who have already had a heart attack or stroke or those who have a very high risk (because of a strong family history or risk factors such as diabetes, smoking and hypertension) the availability of these new medication could be life-enhancing. WOW!