Cardiologist Discusses Alternate Therapies for Patients with High Cholesterol

As treatment options for people with high cholesterol are expanding, experts at Loma Linda University International Heart Institute are ensuring patients have both awareness and access to the options best suited for them.

Dennis Grewal, a cardiologist at the International Heart Institute, says he hopes to close the gap in knowledge about the benefits of non-statin medicines for treating hyperlipidemia. For instance, a class of medicine known as PCSK9 inhibitors has been established as a valuable alternative for people who can’t tolerate statins or non-statins or need additional cholesterol-lowering options.

Hyperlipidemia is a medical condition characterized by elevated levels of lipids (fats) in the bloodstream — particularly cholesterol and triglycerides — that pose a significant risk to cardiovascular health. Elevated levels of cholesterol can heighten the risk of cardiovascular diseases, such as coronary artery disease (angina and heart attacks), stroke, and peripheral artery disease. Grewal says treatment mitigates these risks, reduces the burdens of heart-related symptoms, and improves overall quality of life.

Statins, a common type of cholesterol-lowering medication, are highly effective and well-tolerated, but they can cause side effects in some individuals, Grewal says. Those who don’t tolerate statins have a host of non-statin therapies at their disposal. But when patients don’t tolerate these options, Grewal says PCSK9 inhibitors (evolocumab and alirocumab) are an alternative option with proven efficacy.

PCSK9 is a protein that helps regulate cholesterol. PCSK9 inhibitors prevent the PCSK9 protein from breaking down a receptor on human liver cells that removes cholesterol from the blood. This class of medicines can benefit patients with a genetic condition that causes high cholesterol levels as well as patients who cannot tolerate statins. PCSK9 inhibitors are administered as an injection — every two weeks, every month, or every six months, depending on the type — rather than a daily pill.

Before these newer hyperlipidemia therapies, Grewal says, patients who can’t take statins didn’t have other options. They’d either need to take the lowest doses of statins or take none at all, running all the life-threatening risks of untreated hyperlipidemia.

Lisa Cummings, 54, a patient at the International Heart Institute, had cycled through several statin medications for over a year — but they all made her feel worse. Side effects such as bone and muscle pain deprived Cummings of proper sleep.

“For me, the statins’ side effects were worse than the actual cure,” she says. “I couldn’t do it anymore. The lack of sleep changed my daily activities and made it harder to function.”

So when her cardiologist, Purvi Parwani, recommended the PCSK9 inhibitor evolocumab, Cummings says she was open to trying something new. After two years, Cummings reports no side effects and is pleased with the convenience of administering the medicine through bi-monthly at-home injections.

“It’s just been a game-changer for me,” Cummings says about the newer hyperlipidemia therapy. “My cholesterol levels are looking really good, and I’ve had none of the issues I experienced with statins.”

Grewal says that although PCSK9 inhibitors aren’t yet widely prescribed, they have the potential to help many patients who find themselves in Cummings’ situation.

“When someone comes to clinic thinking that there’s nothing we can do and then you provide them with not just one but several different options, they get excited,” Grewal says. “Sometimes, it mixes with frustration because they wonder why they didn’t know about these options sooner. Seeing patients rejoice in their improved numbers and helping prevent initial as well as recurrent cardiovascular disease is pretty rewarding.”

The original version of this story was posted on the Loma Linda University Health news site.