When Statins Aren’t Enough
We’re always hearing that lowering cholesterol can help reduce the risk of heart disease, heart attacks, and strokes (and also reduce the risk of passing away from any of those conditions). If you have diabetes, you are probably very familiar with a medication class called statins, which are strong LDL cholesterol-lowering medications. But did you know there’s another class of medication you can turn to if your maximum dose of statin isn’t cutting it anymore, or if you are having side effects from it and you’re already following a healthy diet?
Fortunately, there’s a class of medication called PCSK9 inhibitors (PSCK9i). Studies have shown that adding a PCSK9 inhibitor to your cholesterol-lowering plan can help decrease your LDL (“bad cholesterol”) by up to 50 percent!
What Are PCSK9 Inhibitors?
What is PCSK9? And how does inhibiting it (blocking it) result in lower cholesterol? PCSK9, or Proprotein Convertase Subtilisin/Kexin type 9 (I know, let’s stick with PCSK9), is a protein made by the liver that essentially regulates how many LDL receptors we have.
Studies have shown that individuals who have more PCSK9 are more likely to have elevated cholesterol. Based on this principle, scientists came up with a medication that inhibits PCKS9, and by doing so decreases the amount of LDL particles circulating in your bloodstream. The lower the number of LDL receptors, the lower the levels of LDL cholesterol in your blood.
There are currently two FDA-approved medications that inhibit the action of PCSK9: Alirocumab (brand name Praluent) and Evolocumab (brand name Repatha).
Who Might Be a Good Candidate for PCSK9 Inhibitors?
If you have cardiovascular disease and your cholesterol is still high (above 70 mg/dL is considered high if you have heart issues) despite taking other medications like maximum-tolerated statins, or if you have a genetic condition called familial hypercholesterolemia which causes you to have high LDL cholesterol, a PCSK9 inhibitor might be a good option for you.
How Do You Take PCSK9 Inhibitors?
PCSK9 inhibitors are given as subcutaneous injections, which typically you can give to yourself at home. They come in small pens like the insulin pens you are likely familiar with. Injections can be every two weeks or once a month, depending on the formulation.
Are there side effects? Well, the vast majority of people tolerate PCSK9 inhibitors very well. However, a small number of people have reported symptoms like fatigue, muscle pain/soreness, and some swelling around the injection site. Additionally, if you have kidney or liver disease, your provider may not want to start you on this medication, or they may need to adjust your dose.
Despite how effective these medications are, they tend to be on the pricier side, which can make them inaccessible for some people. Over the last few years, insurance companies have been more lenient since these medications ultimately save them money by reducing the high cost of heart conditions in people they cover. It is always a good idea to check the pharmaceutical company’s website directly to see if they offer any assistance programs. If they don’t have a program that will work for you, ask your provider for options, or explore TCOYD®’s access page for additional resources.
While PCSK9 inhibitors are a wonderful class of medication, most people with elevated cholesterol levels do not need to take one to achieve their cholesterol goals. In fact, people are rarely given a PCSK9i as a stand-alone therapy. Instead, these medications are added to a plan that is already in motion to maximize benefits. It’s imperative that you continue following healthy dietary habits and exercise as much as you can while you take a PCSK9i. If you’re interested in trying a PCSK9i, talk to your provider to see if they would be a good option to add to your regimen.
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