The Italian Medicines Agency has approved and granted authorization for the sale of new drugs to treat high levels of cholesterol: these are Evolocumab and Alirocumab, monoclonal antibodies inhibitors of PCSK9 that are able to reduce cholesterol levels by 75%.

Dr. Maddalena Lettino, Head of the Cardiology Unit of Humanitas, spoke about this in a television interview on TV 2000, also giving some advice to patients on how to prevent bad cholesterol (LDL) and instead increase the good cholesterol (HDL).

This type of monoclonal antibodies “blocks the production of bad cholesterol,” explained Dr. Lettino, making it clear that it is a type of drug “completely different from the already known statins, which simply stop the production of cholesterol, while this helps to consume what is already present in our body. “It is administered subcutaneously – added the doctor – like insulin but with a different frequency, once or twice a month, and acts on receptors that help to remove the cholesterol encrustations.

The new drugs will be dedicated to those who suffer from more severe forms of cholesterol and will not replace statins: “it certainly opened a new path, but statins have saved the lives of millions of people” and have “reduced mortality. They remain a great therapy and these new drugs will join them” for the most complex cases.


Bad (LDL) and good (HDL) cholesterol: the differences

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 live without.

The so-called “bad” LDL cholesterol “tends to deposit itself in the walls of the 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, “like a statuette inside our body. At the moment there are no drugs that help to increase good cholesterol, research has tried for a long time but to date the side effects are too many.


The causes

For a long time it was thought that the main cause of the increase in cholesterol levels was a bad diet. It is not so: “although a part derives from this, we have causes of family hypercholesterolemia – explained Lettino – or families in which there is a greater propensity to develop bad cholesterol, even at an early age” and in the same way there is also hypercholesterolemia of genetic type that “is transmitted from mother to child and has high levels of LDL already in childhood and youth. “This is the most serious form and must be sought very carefully by the doctor.


The risks

Those who have high levels of LDL cholesterol risk a thickening of the walls of all blood vessels: cholesterol, in fact, is deposited along the vessels and arteries that instead “should have smooth walls and without fouling” to allow the blood to flow at best and avoid the formation of clots. “When cholesterol accumulates, the vessel narrows and the blood flows with more effort: if the vessel is directed to the heart, there is a risk of a heart attack, and if it transports blood to the brain, there is a risk of stroke,” said the doctor.



What are the symptoms of high cholesterol? None, or almost none: “cholesterol is very insidious and does not give any symptoms”, explained the doctor. “Obviously, in the most serious forms, visible signs appear, for example it is deposited in the eyelids or tendons, but it is already too late because it means that it is also deposited in the walls of the vessels. In order to keep cholesterol levels under control, the cardiology manager recommends that everyone, regardless of their clinical history, “have an initial check on their lipid profile from the age of 40. For those who present cases of family history, it is advisable to start the check-ups from adolescence at least once a year.



In addition to the new drug 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,” explained Lettino. For this reason the doctor tries to change the habits of the patient and to act on the lifestyle before prescribing this treatment. If the values remain high, we start the therapy with statins that “block the production of cholesterol in our body and reduce the amount of bad cholesterol,” concluded the doctor.

In any case, for those who have cholesterol problems, it is advisable to follow a healthy diet, preferring the Mediterranean diet low in animal fats (butter, lard, lard, whole milk) and rich in vegetables, fish (2-3 times a week), white meat and carbohydrates preferring the whole grain ones.