As of: March 29, 2024, 5:05 a.m
By: Andreas Beez
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A new drug helps lower high cholesterol. Heart professor Volker Klauss explains the injection against heart attack and stroke.
Millions of people struggle with elevated cholesterol levels. A maximum of 30 percent of cholesterol levels can be reduced through diet, and regular exercise can also help. Those affected often have to take additional medication - especially if they have vascular diseases such as coronary heart disease or an inherited lipid metabolism disorder; In the latter case, doctors speak of familial hypercholesterolemia.
New drug ensures that the liver can break down more cholesterol
So far, most cholesterol patients have taken so-called statins. “They are practically the basic medication for high cholesterol levels,” explains Munich heart specialist Professor Volker Klauss (cardiology city center). In recent years, however, other cholesterol-lowering drugs have come onto the market. Recently, the drug Inclisiran received particular attention in specialist circles. It belongs to the group of so-called PCSK9 inhibitors and is administered as an injection under the skin. That is why it is often referred to as an “injection against heart attack”. “These PCSK9 inhibitors ultimately ensure that the liver can absorb and break down more harmful LDL cholesterol,” explains Klauss.
Inclisiran injection only required every six months
Heart specialist Professor Volker Klauss advises keeping an eye on cholesterol levels - especially if you have other risk factors for cardiovascular disease. © Andreas Koehler
The big advantage of inclisiran: In contrast to other PCSK9 inhibitors such as evolocumab and alirocumab, it does not have to be injected every two or four weeks. Instead, the injection is repeated once after three months and is then only required every six months. According to previous study results, inclisiran is able to reduce LDL cholesterol by half and thus reduce the risk of developing arteriosclerosis by 60 to 90, reports the German Heart Foundation.
High cholesterol: More than half of Germans have high cholesterol levels
High-risk patients in particular can benefit massively from this effect. The medical background: Elevated cholesterol levels should not be taken lightly. They are one of the biggest risk factors for stroke and heart attack, especially in old age - especially in combination with other stresses such as smoking, too much alcohol, obesity, diabetes and high blood pressure. That's why everyone's cholesterol levels should be determined so that patients at risk can be identified and treated early. “This also includes the one-time determination of the so-called lipoprotein (a), another factor from fat metabolism that can cause vascular diseases,” explains Klauss.
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Cholesterol in moderation is an important building block for cells and hormones
Cholesterol is produced in the liver and absorbed through food. It is used as a building block for the body's cells and, in moderation, plays a role in the formation of bile acid and the production of important hormones. “So that the cholesterol can be transported into the body via the individual blood vessels, the body packs the fats into protein packets and forms lipoproteins, consisting of fat (lipid) and protein (protein): LDL cholesterol and HDL cholesterol,” explains the foundation German Stroke Aid.
High cholesterol causes heart attacks and strokes
In particular, LDL cholesterol (low density lipoprotein) can accumulate in the vessel walls and thereby fuel the gradual process of vascular calcification, which is technically known as arteriosclerosis. “The arteries become increasingly brittle or stiff and narrow,” explains cardiologist Klauss. “In the worst case, the blood vessel closes completely, downstream tissue can no longer be supplied with oxygen - and the dreaded catastrophe in the heart or brain occurs, for example.” In Germany, almost 200,000 people suffer a heart attack and almost 270,000 suffer one every year Stroke. Many victims die or remain permanently dependent on outside help after becoming ill. According to a survey by the renowned Mayo Clinic in the USA, almost three million deaths worldwide are associated with high LDL cholesterol levels.
Causes of increased cholesterol levels can include an unhealthy lifestyle (poor diet, too much alcohol, obesity and lack of exercise) and, as already mentioned, a hereditary predisposition (familial hypercholesterolemia). “Various diseases, such as diabetes or impaired kidney function, can potentiate the negative effects of high cholesterol levels,” says Klauss.
Lowering high cholesterol levels: Statins as proven basic medications
To get the risk factor cholesterol under control, medications have long been used successfully - especially statins. “They have been available since 1987 and practically serve as basic medications for elevated cholesterol levels,” reports Klauss. According to the long-time LMU scientist, statins have been well researched. The good tolerability was only recently confirmed again in a large study that was published in the renowned journal “The Lancet”. According to this, only one out of 15 patients who were treated with statins had side effects that were caused by the statin therapy.
Professor Klauss: Side effects of statins can be controlled with good attitude
There are always rumors circulating about statins that they often cause serious side effects or can even cause serious illnesses - for example Alzheimer's dementia. But these claims have been refuted in studies, including Australian research from the University of South Wales. However, it is undisputed that muscle problems can occur when taking statins - especially at high doses. “These problems can usually be avoided by carefully adjusting the medication. The most important thing is to carefully approach the optimal dose at the beginning of therapy,” advises heart specialist Klauss.
These drug combinations are often prescribed to treat high cholesterol levels
When statins are not enough to lower cholesterol levels, they are often combined with ezetimibe - a drug that reduces the absorption of cholesterol from the intestine. Another often prescribed variant is the combination of ezetimibe and bempedoic acid. The latter - similar to statins - inhibits cholesterol absorption in the liver, but is said to cause less muscle pain. Cardiologist Klauss sees the newer medications in syringe form as a good addition to the therapy options. “They are particularly useful for patients for whom the tablets do not have the desired effect.”
However, Klauss continues, injection therapy alone is usually not enough for most patients. “A combination will almost always be necessary.”