What Happens When Statins Don’t Work?

Statins are a great group of medications that have been around since about the 1980’s. They work by inhibiting an enzyme in the liver called HMG-CoA reductase and by inhibiting that enzyme, you’ll actually prevent the liver from producing cholesterol.

Even though statins are a great group of medications, they don’t work for everyone. One reason they may not work is because we may see some reduction in cholesterol but not enough. Another reason statins may not work is

because patients can have side effects from them. The most common side-effect we hear about is muscle aches and pains. And the last thing we worry about with statins are that they can actually cause liver damage because that’s where they are metabolized in the body.

If statins aren’t tolerated or if they’re just not the right medication for the patient for whatever reason, there are several different medication options that are available to patients. All of these medications either work by preventing production of cholesterol in the liver

or by preventing the uptake of cholesterol in the gut. These other agents may be better tolerated by patients because they usually don’t have the same side effects of the muscle aches and pains, and also some of them are not metabolized in the liver,

so they don’t have that same effect of causing liver damage. PCSK9 inhibitors are a new class of medications that may be available to patients to help reduce their cholesterol. By inhibiting a protein in the liver, that’s responsible for the production of cholesterol.

The latest data that we have on this group of agents comes to us from three trials that were recently published in the New England Journal of Medicine. So in these three trials, Patients, everyone received a statin but half the group received a placebo drug

and the other half received the PCSK9 inhibitors. And what we found is that patients that received the PCSK9 inhibitors actually had a significant reduction in their total cholesterol, and specifically their LDL - which is often times referred to as someone’s bad cholesterol.

As with all medications, there are some downsides. One of the most common side effects that patients complained of when receiving these medications were neuro-cognitive difficulties - so things like having difficulty concentrating or just feeling like their mind was a little bit fuzzy.

Also, these medications are only available as an injection. They have to be given every 2 to 4 weeks, and you have to go to your doctor’s office to receive them. And the last thing that may particularly hit home for a lot of Americans is that these medications are expensive.

Currently, the estimated cost for a year’s worth of treatment with PCSK9 inhibitors is somewhere between $7,000-$12,000 a year. While we do have good data to show that PCSK9 inhibitors can lower cholesterol, the next question researchers have to answer is whether or not this reduction in total cholesterol and LDL actually translates

into lower rates of heart attacks, death, and stroke. We have that data on statins, Is it going to be same for PCSK9 inhibitors?