Need to Lower Your Cholesterol?

As we grow older, maintaining heart health becomes increasingly important, and one crucial factor to consider is your cholesterol level, which serves as a significant indicator of your risk.

According to the Centers for Disease Control and Prevention (CDC), 11.3% of American adults have high levels of total cholesterol. The rates are even higher (16.7%) for adults ages 40-59, when other heart health concerns also become more prevalent.

Several factors play a role in cholesterol levels, including diet, exercise and weight loss. Many of us also rely on cholesterol-lowering medications as part of that equation.

The most common cholesterol-lowering medications are known as statins, and they are typically taken in tablet or capsule form. These have been in use since the 1980s.

According to the American Heart Association, statins actually help prevent cholesterol from forming in the liver. This makes them most effective at lowering levels of bad low-density lipoprotein (LDL) cholesterol, but they also have an impact on lowering triglycerides and raising levels of good high-density lipoprotein (HDL) cholesterol. Several different types of statins are available and may be prescribed based on your specific diagnosis.

When statins aren’t enough

While technically around since 2015, this “new” medication is a fairly new kid on the block for lowering cholesterol. It is particularly effective at bringing levels down when statins or other medications alone have not been effective. These drugs are known as PCSK9 inhibitors.

“PCSK9 stands for proprotein convertase subtilisin/kexin type 9, which is a type of protein made in the liver that binds to the LDL receptor and signals it for destruction,” says Andrew Bromley, M.D., a cardiologist with the University of Miami Health System. “The LDL receptor, manufactured in the liver, is needed to clear cholesterol from the bloodstream. Therefore, these medications allow the body to regulate the expression of the LDL receptors in the liver and make them more effectively clear cholesterol from the bloodstream.”

There are three types of PCSK9 inhibitors currently available.

Two of them are classified as monoclonal antibodies, while the third one is known as small-interfering RNA (siRNA).

Monoclonal antibodies:

• Repatha (evolocumab)
• Praluent (alirocumab)

siRNA:

• Leqvio (inclisiran) [3]

“The monoclonal antibodies, which include evolocumab and alirocumab, are self-administered by the patient at home via subcutaneous injection every two weeks,” says Dr. Bromley. “Inclisiran must be administered in a medical setting, such as our clinic, by a medical professional, every 6 months.”

How PCSK9 inhibitors help your heart health.

If lifestyle changes and other medications such as statins have not sufficiently lowered your LDL cholesterol, then your provider may prescribe PCSK9 inhibitors. PCSK9 inhibitors may be recommended for a few other reasons, as well.

“There are instances in which patients cannot tolerate certain drugs, such as statins, and therefore may necessitate a PCSK9 inhibitor,” says Dr. Bromley. “Many patients with inherited cholesterol disorders have markedly elevated LDL cholesterol levels and often require dramatic LDL cholesterol lowering to get to goal.”

For those who do add PCSK9 inhibitors to their cholesterol-lowering regimen, the results are often dramatic.

“There have been multiple large-scale trials involving the PCSK9 inhibitors,” says Dr. Bromley. “They have demonstrated these medications to be exceptionally safe and lead to robust LDL cholesterol lowering, on the order of 50-60%. Inclisiran is also associated with a robust LDL cholesterol lowering of approximately 50%.”

How to maintain a healthy cholesterol level.

Despite the effectiveness of PCSK9 inhibitors and other cholesterol-lowering drugs, they are just one small piece of the puzzle when it comes to living a heart-healthy lifestyle.

Dr. Bromley advises the following measures to maintain healthy cholesterol levels in conjunction with medication.

• Eat heart healthy. Focus on a heart-healthy diet that consists of whole foods, lean protein sources, fruits and vegetables. Limit unhealthy food sources like sugars, refined carbohydrates and saturated fats.
• Go Mediterranean. The Mediterranean diet is a great way to eat that’s heart-healthy but still offers plentiful interesting food and meal choices.
• Stay active. Aim for at least 150 minutes or more of moderate-intensity aerobic activity each week.
• Maintain a healthy weight. Staying at a healthy weight for your frame is key to keeping high cholesterol at bay.
• Avoid tobacco. Smoking and tobacco use are also key contributors to high cholesterol, heart disease and other health problems.

Written by Wyatt Myers, a contributor for UHealth.

Tags: cholesterol management strategies, Dr. Andrew Bromley, heart disease prevention tips, injectable cholesterol medications, LDL reduction techniques