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Drug May Help Lower Bad Cholesterol Beyond Statins

Injectable therapy shows promise in global trial but more study needed, researchers say

WebMD News from HealthDay

By Dennis Thompson

HealthDay Reporter

TUESDAY, May 13, 2014 (HealthDay News) -- A new injectable drug can further knock down cholesterol levels in people who take cholesterol-busting statin medications, according to the results of a global trial.

People taking the new therapy alongside statins enjoyed a 63 percent to 75 percent decrease in their "bad" (LDL) cholesterol levels, on top of the reduction caused by the traditional statin medications, researchers reported. The findings are published in the May 14 issue of the Journal of the American Medical Association.

"This drug enhances the body's natural way of reducing LDL levels in the bloodstream," said lead author Dr. Jennifer Robinson, a professor of epidemiology and cardiology at the University of Iowa College of Public Health. "It lets us get cholesterol really well-treated in people with genetic cholesterol disorders or people who can't take large amounts of statins."

Evolocumab is a so-called "human monoclonal antibody" that, in a roundabout way, improves the body's ability to remove cholesterol from the bloodstream.

Cells primarily located in the liver contain receptors that target LDL cholesterol and remove it from the bloodstream. But the liver also produces a regulatory protein called PCSK9 that binds to and breaks down these receptors, Robinson said.

The antibodies in evolocumab are designed to intercept PCSK9, preventing the protein from breaking down the cells' LDL receptors, which allows them to stay in circulation longer to remove LDL cholesterol, she explained.

The phase 3 clinical trial was funded by the drug's maker, Amgen, and conducted at 198 sites in 17 countries. Over the course of 12 weeks, just over 2,000 people taking moderate to high doses of statins were randomly assigned to also take evolocumab, or another cholesterol-lowering drug called ezetimibe (Zetia), or an inactive placebo.

Compared with the placebo, evolocumab taken every two weeks reduced LDL cholesterol levels an additional 66 percent to 75 percent, and taken monthly cut the level by 63 percent to 75 percent. By comparison, ezetimibe provided an additional cholesterol reduction of up to 24 percent, the investigators found.

According to the findings, evolocumab had adverse events and side effects comparable to those experienced by people taking either statins or ezetimibe. "Because it's a very specific antibody, it seems to be very well-tolerated without any drug interactions or any side effects," Robinson said.

Evolocumab will be mostly helpful in treating people with a genetic disorder that causes them to have high cholesterol, Robinson said. About 1 in 500 people have this disorder, according to the U.S. National Institutes of Health.

It also could help people with high cholesterol who can't take large doses of statins, Robinson added, estimating that as many as 10 percent of people with heart disease or diabetes can't tolerate the recommended dose of statins.

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Your total cholesterol level is Borderline High, but fortunately your level of "bad" LDL cholesterol is near optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have other non-measured increases in LDL-like particles that can increase heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol level is Borderline High. Your level of "bad" LDL cholesterol is Borderline High, too. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol level is Borderline High. Your level of "bad" LDL cholesterol is High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol level is Borderline High. But your level of "bad" LDL cholesterol is Very High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol is High, but your level of "bad" LDL cholesterol is optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have elevated secondary lipids, such as non-HDL particles that increase the risk of heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol is High, but your level of "bad" LDL cholesterol is near optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have elevated secondary lipids, such as non-HDL particles that increase the risk of heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol level is High. Your level of "bad" LDL cholesterol is Borderline High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol level is High. Your level of "bad" LDL cholesterol is High, too. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels! If you are struggling to bring down your total cholesterol and LDL cholesterol levels, your doctor may prescribe medication, such as statins. Following medication, dietary, and exercise instructions should result in improvements.

Your total cholesterol level is High, and your level of "bad" LDL cholesterol is Very High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels! If you are struggling to bring down your total cholesterol and LDL cholesterol levels, your doctor may prescribe statins or other cholesterol-lowering medications.

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