A major new study has found that treating high cholesterol more aggressively and earlier in life may help prevent heart disease before it develops. The research shows that a drug called evolocumab can significantly reduce the risk of heart attacks and strokes in people with diabetes who are at high risk, even if they do not yet have visible artery damage.
Heart disease often develops silently over many years. Fatty substances build up in the arteries, gradually narrowing them and reducing blood flow. This process can eventually lead to serious events such as heart attacks or strokes. Many people do not know they are at risk until these events occur.
Doctors usually focus on treating people who already have clear signs of artery blockage. These patients are often given medications like statins to lower their cholesterol. While this approach has been effective, it may come too late for some individuals.
The new study, published in JAMA and presented at a major cardiology meeting, suggests that earlier treatment could provide additional protection. Researchers from Mass General Brigham studied more than 3,600 people with diabetes who were considered to be at high risk of heart disease.
These participants did not have clear evidence of atherosclerosis, which is the buildup of plaque in the arteries. However, their long history of diabetes or need for insulin meant they were still at significant risk.
The researchers divided participants into two groups. One group received evolocumab injections every two weeks, while the other group received a placebo. Both groups continued their usual treatments, including statins and other cholesterol-lowering medications.
Evolocumab works differently from traditional drugs. It blocks a protein that normally reduces the body’s ability to remove cholesterol. By blocking this protein, the drug allows the body to clear more cholesterol from the blood.
After about one year, the difference between the two groups was clear. People taking evolocumab had much lower levels of LDL cholesterol. Their levels were reduced by about 50 percent compared to those who did not receive the drug.
The researchers then followed the participants for several years to see how this affected their health. Over nearly five years, those who received evolocumab were much less likely to experience a first major cardiovascular event. These events included heart attacks, strokes, or death related to heart disease.
The risk reduction was about 31 percent, which is a meaningful improvement. Fewer people in the treatment group experienced serious problems compared to those who received standard care alone.
The study also found that the treatment was safe. There were no major differences in serious side effects between the two groups, suggesting that the drug can be used safely in this population.
These findings suggest that lowering cholesterol earlier and more intensively could help prevent heart disease before it starts. This could be especially important for people with diabetes, who often have a higher risk of heart problems.
However, the study also has some limitations. It focused only on people with high-risk diabetes, so it is not clear whether the same benefits would apply to other groups. In addition, the cost of newer drugs like evolocumab may limit their use in routine care.
More research is needed to understand how best to use this treatment and whether it should be recommended more widely. Future studies may explore its effects in different populations and over longer periods.
In conclusion, this research suggests a shift in how we approach heart disease prevention. Instead of waiting for damage to appear, early and strong treatment of cholesterol may help stop disease before it begins.
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Source: Mass General Brigham.
