Keep it Down

42422693 - ill senior man taking medicine for hypertension

// by Emily Goldman

Newborn Babies  cry, sleep, poop and have amazing cholesterol. A recent study compiled by Imperial College London showed that lowering an adult’s cholesterol levels to that of a newborn can significantly reduce a person’s risk of heart disease, and that a relatively new drug called alirocumab can help patients achieve ground-breakingly low Low-Density Lipoprotein (LDLs).

According to the Mayo Clinic, LDLs, also known as the “bad” cholesterol, move cholesterol particles throughout the body. LDL cholesterol can build up in the walls of arteries, making them hard and narrow, putting patients at risk for heart disease.

Alirocumab, a PCSK9 inhibitor, is a monoclonal antibody. These antibodies target and inactivate a specific protein in the liver. By eliminating the protein, the antibodies reduce the amount of LDL in the bloodstream.

The lack of information on patients with extremely low LDL levels made many doctors unsure. Now, however, with the new findings, doctors have a precedent to follow.

The Imperial study reviewed results of more than 5,000 participants in 10 cholesterol-lowering trials. The findings discovered that lowering a patient’s cholesterol levels to those of a newborn did not pose any major risks to the patient, placating previous concerns. Possible side effects of lowering cholesterol too much, according to Dr. Marc Litt of Baptist Health, are muscle aches and memory issues.

“People are doing okay and their neurological status is seemingly fine,” says Litt after reviewing the study. “The simple thing is to say, now where the worry has been that maybe if you lower your cholesterol [extremely low] it would cause harm—there’s good evidence to suggest it’s helpful. The development was based on unique patients with a chromosome abnormality with very low cholesterols and were very healthy.”

While drugs to lower high LDL numbers, called statins, have been around for some time, the study also found that in addition to the use of statins, alirocumab can help patients achieve cholesterol levels comparable that of a newborn, whose LDL levels are usually below 50, according to Litt.

“Personally, in all the years I’ve been a doctor, has anything [concerning high LDLs] been preventative? No. It just doesn’t work that way. And it’s still not completely proven,” cautions Litt. “You can say that by lowering the LDL it appears that people tolerate extremely low LDLs and it may in the future prevent heart disease.”

“Statin therapy, at most, lowers cholesterol 55 percent,” says Dr. Ragu Murthy, cardiologist at St. Vincent’s. “These new drugs, called PCSK9s, lower cholesterol sometimes to undetectable levels.”

These extremely low levels, or rather those of an infant, bring the study full-circle, showing that the low numbers are relatively safe.

“I prescribe this drug to my patients who have had either a heart attack or progression of their coronary artery disease despite high-dose statin therapy. I also prescribe it to patients who have a genetic mutation which results in a very high LDL level,” says Murthy. “Also, I prescribe it to patients who are intolerant to statin therapy due to severe muscle pains.”

The combination of the use of statins and PCSK9 inhibitors bring down LDL levels, and help alleviate a patient’s risk for heart disease. Further, the study found that these extremely low levels resulting from the use of PCSK9 inhibitors pose little to no significant health risks.

“This study is the beginning of several studies showing the benefit of this group of drugs. I believe that other studies will continue to show benefits in this class of drug,” says Murthy.

Of course, with every upside there’s usually a downside. PCSK9 inhibitors are expensive medication, needing to be injected by a doctor twice a month.

“These drugs, however, are very expensive and, in a world of limited resources, we will need to figure out what is the best way to utilize these new tools we have,” says Murthy.

Cutting-edge medications aside, lifestyle changes like eating heart-healthy foods such as those with healthy fats and fiber like beans, oats, fruits and vegetables, getting more exercise, cutting down on alcohol and quitting smoking are proven ways to keep your heart young and your cholesterol down—and they don’t require a prescription.