They are called Evolocumab and Alirocumab and they are monoclonal antibodies to PCSK9 inhibitors that have been shown to reduce cholesterol levels by up to 75% of their baseline value. The Italian drug agency has just approved and granted permission to sell these two new drugs precisely to treat high cholesterol levels. We talked about it with Dr. Maddalena Lettino, head of the Humanitas cardiology unit. The specialist also provided some advice to prevent high levels of bad cholesterol (LDL) and increase good cholesterol (HDL).
How the new cholesterol drugs work
The new drugs, administered as insulin subcutaneously once or twice a month, will be reserved for those suffering from more severe forms of hypercholesterolemia and will not replace the statins, but will be added to them in most cases. “Surely the two new drugs have opened a path, but without forgetting that the statins have saved the lives of millions of people and have reduced cardiovascular mortality. Therefore, they remain a great therapy to which the new drugs will be associated for the most complex cases,” said Lettino. “This type of monoclonal antibodies significantly reduces the levels of bad cholesterol,” explained the specialist, making it clear that these are completely different drugs, which instead of stopping the production of cholesterol help to eliminate the excesses already present in our body.
Cholesterol, what is the difference between bad and good cholesterol?
Cholesterol is a fundamental substance for our body: it is present in all the cells of our body and is essential for the production of many substances, including several hormones that we could not do without. “The so-called “bad” LDL cholesterol tends to deposit itself in the walls of blood vessels and produce atherosclerosis, the disease that preludes the development of heart attack and stroke,” explained the doctor. It should never exceed 115 mg/dl, in which case “we are in a phase of risk” that must be checked by the doctor. The “good” cholesterol, instead, helps to remove the bad one from the circulation and its levels must be high, above 40 or 60 mg/dl. “It is as if it were a natural drug that removes the bad cholesterol circulating in our body,” explained Lettino, “at the moment there are no drugs that help to increase the good cholesterol, research has tried for a long time but today the side effects are too many.
Food is not the only factor that can contribute to high cholesterol
“Cholesterol is certainly introduced with food but it is also produced internally, and this production can overcome the needs of the body and lead to an excess of circulating cholesterol – said the specialist, explaining that the role of food is often overestimated. There is a more general hypercholesterolemia and there is the so-called family hypercholesterolemia, which is a real genetic disease, transmitted within families, from parents to offspring, and associated with particularly high levels of LDL cholesterol and a high risk of cardiovascular disease. This is the most serious form and should be sought very carefully by the doctor. People with high levels of LDL cholesterol risk the thickening of the walls of the arterial vessels and the formation of atherosclerotic plaques: “When the cholesterol accumulates and the atherosclerotic plaques protrude inside the lumen of the vessels, it narrows and the blood flows with more effort: if the vessel is directed to the heart you risk a heart attack, if it brings blood to the brain you risk a stroke,” said the doctor. Cholesterol, in fact, is deposited along the vessels and arteries that should instead have smooth walls and without incrustations to allow the blood to flow better and avoid the formation of clots.
Symptoms of high cholesterol
What are the symptoms of high cholesterol? Of course, in the most severe forms of hypercholesterolemia there are visible signs, accumulations of cholesterol in the eyelids or tendons, in the form of small yellowish masses of soft consistency, but it is already too late because it means that it has also deposited in the walls of the vessels.
In order to keep cholesterol levels under control, the doctor recommends that everyone, regardless of their clinical history, should have an initial check on their lipid profile from the age of 40. If the values are high, we start the therapy with statins that block the production in our body and reduce the amount of bad cholesterol. In any case, for those who have cholesterol problems, it is advisable to follow a healthy diet, preferring the Mediterranean diet, which is low in animal fats and rich in vegetables, fish, white meat and carbohydrates, preferring the whole diet. For those who present cases of family history, it is good to start the checks since adolescent age at least once a year. In addition to the new drugs approved by the Italian Medicines Agency, cholesterol is kept under control by administering statins; a therapy that once started should be carried out throughout life. For this reason the doctor tries to change the habits of the patient and to act on the lifestyle before prescribing this treatment.