Want Lower Cholesterol? Prepare to Go Broke...

Written by Dr. Jack Wolfson
Posted August 31, 2015

Want to really lower your cholesterol? Better get out your checkbook. The estimated price of a new class of drugs to lower cholesterol is around $15,000 per year.

Personally, I think excess cholesterol is a small part of the equation when it comes to heart attacks. High lipid levels are a product of poor nutrition and environmental toxins. Improve these factors and the body will resume healthy cholesterol production.

Sadly, most doctors are not interested in causation and recommend millions of people take statin drugs to lower cholesterol, and presumably, lower the risk of a heart attack, stroke, and dying. I joke with my patients that heart attacks are not from a statin deficiency. Advertisements for Crestor, Zocor, and Lipitor amongst others occupy a large chunk of TV time. These drugs lower LDL particles by interfering with the production of cholesterol. They are also a multi-billion dollar business...

LDL, or low-density lipoprotein, is produced in the liver. It is like a bus that carries passengers around the body. One of the passengers on the LDL bus is cholesterol. The fewer passengers there are, the fewer buses needed.

The fact that statins lower numbers is not up for debate. But statins do not appreciably decrease the risk of heart attacks, strokes, and death. This is especially true for primary prevention… people who have never had a heart attack or required a stent or bypass surgery.

In fact, most statin trials for primary prevention found a 3-4% benefit in the drug group versus placebo. And that was after several years of treatment. Mortality benefit (the question of whether a treatment saves lives) was small, if any. The data is better for secondary prevention for those who have had a heart attack.

The goals of cholesterol reduction keep getting lower and lower. Interestingly, recent guidelines from the American College of Cardiology have removed the LDL number as an endpoint. It believes that 1/3 of the adult population should just take the statin drug.

Since millions still suffer heart attacks and require interventions such as stents and surgery, a new class of drugs was developed to lower cholesterol and LDL to levels never seen before, outside of cancer patients, that is. The drugs are called PCSK9 inhibitors and are taken in conjunction with statins. Millions of patients refuse statin therapy because of side effects such as muscle discomfort, liver issues, or memory loss. These people may qualify for PCSK9 use because of statin intolerance.

So this new class of drugs — with names like Praluent and Repatha — is sure to be all the rage in the cardiologist’s office. Insurers must be quaking in their boots thinking about the expenses. At almost $15,000 per year, they should be. The stock prices of the corporations who brought these drugs to market have skyrocketed.

The PCSK9 class works differently from statins to lower LDL numbers. They inhibit the breakdown of the LDL receptor on the liver. These receptors are like tiny catchers' mitts on the liver surface and are there to catch LDLs and pull them out of circulation. The new kids on the block are injectable, requiring a shot every two weeks, so compliance may be an issue.

In a recently published study on the PCSK9 Praluent, LDL was dramatically reduced and the combined endpoint of death from coronary heart disease, nonfatal myocardial infarction, stroke, or unstable angina was reduced from 3.3% to 1.7%. The study lasted 18 months.

The unfortunate news was that muscular complaints were almost double that of placebo, and brain complaints were more than twice as likely. This is not surprising given how important cholesterol is to the body.

Cholesterol has gotten a bad rap for over 50 years. Never mind that this molecule makes up a large part of the cell membrane (the fence surrounding every cell), builds sex hormones, gets converted into vitamin D, and is a key component of digestion. It is no wonder that many studies find that older folks with higher cholesterol levels live longer.

There are no long-term studies on these new drugs. Whether or not they lower heart attacks and strokes will continue to be studied. We won't get large-scale trials on life and death benefits until 2017. Stay tuned.

Interestingly, a natural supplement called berberine has a similar action to the PCSK9 drugs. It also prevents the breakdown of LDL receptors on the liver, although not nearly to the same degree as the pharmaceutical. Berberine has also been compared to prescription metformin for blood sugar control. The two are equivalent.

My goal in practice is to get my patients off drugs. There are better ways through good nutrition, toxin avoidance, sleep, relaxation, and physical activity. Use evidence-based supplements when needed. In my opinion, there is too much unknown and too much expense to rush into the new drugs.

Dr. Jack Wolfson

Senior Editor, Clear Health Now

Dr. Jack Wolfson DO, FACC is a board-certified cardiologist who believes bad nutrition and toxins create heart health problems. He prevents and treats cardiovascular disease with good nutrition, not medicines and treats the whole person, not just the symptoms.

He is the author of The Paleo Cardiologist: The Natural Way to Heart HealthYou can find out more about Dr. Wolfson at The DRs Wolfson.

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Robinson, J. et al. N Engl J Med 2015; 372:1489-1499

Downs, J. et al. JAMA. 1998;279(20):1615-1622.

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