Scientists from Bert Aertgeerts and elsewhere suggest that additional cholesterol-lowering drugs should be offered to patients with high levels of ‘bad’ (LDL) cholesterol (70 mg/dl or higher) who are also at high risk of heart disease.
The research is published in The BMJ and was conducted by Qiukui Hao et al.
In the study, the drugs assessed by the panel are ezetimibe and PCSK9 inhibitors. They work by reducing the absorption of cholesterol from foods and the production of cholesterol in the body.
The recommendations apply to adults already taking the maximum dose of statins or those who are intolerant to statins.
The team considered the balance of benefits against the burdens and potential harms of starting a new drug according to patients’ level of risk, values and preferences.
Their advice represents a shift from the traditional focus on lowering cholesterol levels to a focus on reducing a person’s overall heart disease risk.
New evidence from 14 trials involving 83,660 patients shows that ezetimibe and PCSK9 inhibitors probably reduce heart attacks and strokes in patients with very high and high cardiovascular risk, but not in patients with moderate and low heart risk.
The team found these relative benefits were consistent, but their absolute magnitude varied based on heart risk in individual patients.
No important side events were found, although PCSK9 inhibitors require injections that sometimes result in injection site reactions, which the experts say is a burden and harm that may matter to patients.
PCSK9 inhibitors are also more expensive than ezetimibe and statins.
Based on these factors, the panel favors ezetimibe over PCSK9 inhibitors, but they suggest that both would provide important benefits for adults in the high and very high-risk group, but would be of little benefit for adults in the low-risk group.
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