New cholesterol-reducing drug "a blessing"

Heart attack survivor John Long, 73, said a new treatment to manage cholesterol in high-risk patients has been a blessing.

Long, a patient of cardiologist Francis Q. Almeda, MD, FACC*, of Advanced Heart Group, S.C. practicing at the University of Chicago Medicine Ingalls Memorial, had a heart attack in 2010.

“I was shocked when I had the heart attack. I didn’t realize my cholesterol was an issue,” Long said.

Almeda said high cholesterol, often determined by a low-density lipoprotein (LDL) cholesterol level of over 100 mg/dL in high risk individuals, can elevate the risk of a heart attack or stroke. Long’s LDL cholesterol levels varied from 110 mg/dL to 125 mg/dL.

Long underwent quadruple coronary artery bypass surgery at another hospital and was prescribed a statin, one of the most widely prescribed drugs to reduce LDL cholesterol levels. He quickly developed serious side effects from the drug, however, including severe weakness, joint pain, jaundice and trouble urinating.

“For about two weeks I started getting weak and having lack of urine movement,” Long explained.

He visited the Urgent Care at Ingalls Flossmoor Family Care Center, and from there was admitted to the hospital and diagnosed with renal failure. After five days of dialysis in the hospital, under the treatment of nephrologist Daniel Yohay, MD*, and another 10 months of outpatient dialysis, the condition of Long’s kidneys improved.

After fighting prostate cancer at Ingalls Cancer Care Center three years ago, Long sought further treatment for his high cholesterol from Almeda about eight months ago.

“It was getting to the point of doctors saying, 'What can we do?'" Long said.

Almeda suggested a new treatment, specifically tailored for lowering elevated LDL cholesterol, called PCSK9 (proprotein covertase subtilisin/kexin tyoe 9) inhibitors. The drug is offered in two FDA-approved formulations to lower LDL cholesterol levels in patients who are intolerant of statins. The prescriptions are administered as injections under the skin.

PCSK9 inhibitors target harmful proteins in the liver. Liver cells have useful receptors that get rid of excess cholesterol, but the PCSK9 proteins “tag” these receptors, increasing their destructive ability. These inhibitors latch onto the bad PCSK9 proteins and block them from acting. This results in increased receptors on the liver cells and increased clearance of LDL particles, thus lowering the cholesterol in the blood.

“The cornerstone of management of high cholesterol is still statin therapy,” Almeda said. “It is important to remember that statins are very safe and effective, and that serious side effects are rare, and for the most part reversible. But it is reassuring to know that there are now excellent options for high risk patients who truly cannot tolerate statins."

"The good news is that recent clinical trials have clearly shown that PCSK9 inhibitors not only potently lower LDL cholesterol, but significantly decrease the risk of heart attack and adverse cardiovascular events over time," Almeda said.

The medical staff instructed Long how to self-administer the injection in his abdomen twice per month, and he was able to tolerate a very small dose of statin medication as well. He said he hasn’t experienced any side effects, and his cholesterol levels have been consistently below 70 mg/dL.

“I’m a believer in keeping my LDL under 100 mg/dL, ideally less than 70 mg/dL,” Long said. “I feel great. Between my prayers, others’ prayers for me, and the new medicine, it’s been a blessing.”

Long said he’s also committed to living a heart healthy lifestyle by eating a low fat and low sodium diet and exercising daily on a stair stepper. Good health allowed Long to travel to Spain last fall to visit his son.

Long now sees Almeda every four to six months for regular follow-up appointments.

“In spite of all the challenges, he stuck with the treatment strategy,” Almeda said. “He didn’t give up, despite the many bumps along the road. He is a perfect example how, with shared decision making and careful consideration of the unique clinical risk factors, cost and individual preferences, we can achieve optimal patient-centered care.”

Almeda added that even people with relatively “normal” cholesterol levels should get regularly screened, particularly if they have conditions or a family history that would put them at high risk for cardiovascular disease. Although statins are still the the most popular option and first-line strategy for treatment of high cholesterol, there are now other options that should be thoughtfully considered.

*Dr. Almeda and Dr. Yohay are independent medical practitioners and are not employees or agents of Ingalls Memorial Hospital or University of Chicago Medical Center (“UChicago Medicine”).