Health Matters: PCSK-9 inhibitors not for everyone
Q. I just saw a news report about a new injectable medicine that lowers cholesterol dramatically more than anything does now that's available. Is it for me? A. A major study was reported earlier this month that demonstrated the value of one versi...
Q. I just saw a news report about a new injectable medicine that lowers cholesterol dramatically more than anything does now that's available. Is it for me?
A. A major study was reported earlier this month that demonstrated the value of one version of this new class of medicines-called PCSK-9 inhibitors-in reducing various consequences of high cholesterol such as death from heart disease, heart attacks, strokes, hospitalizations, and the need for more stents or cardiac surgery. The people who were studied all had evidence of cardiovascular disease (such as by having already suffered a heart attack), were at high risk of vascular complications, and were already taking a medicine (called a statin, such as Lipitor or Zocor) to lower their cholesterol levels. When the PCSK-9 inhibitor was added to the statin, the risk of having one of the effects mentioned above was reduced by about 15 percent. Even more dramatic was how much the bad cholesterol levels were reduced-from an average of 92 down to 30! And the drug was well-tolerated, with surprisingly few side effects.
These beneficial effects were balanced by some negatives. First, the drug is incredibly expensive-more than $14,000 a year. One analysis suggested that the cost to the country could be $120 billion if all potentially eligible patients took it. Additionally, the follow-up period in the patient study was only a little over two years, so we don't have good long-term data. And finally, we don't really know if the results apply to the majority of people walking around with cholesterol problems who are at lower risk. So most people shouldn't be prescribed a PCSK-9 inhibitor-at least at present. This recommendation may change as we learn more about these drugs (and, we hope, the prices come down). Only those at high risk or unable to tolerate a statin or both would be considered good candidates now.
Q. I'm not in the medical profession, but I am learning how to do CPR just in case. But since I'm far from being an expert, will I be able to make a difference if someone collapses?
A. Yes, but ... Yes, because what we refer to as bystander-initiated efforts to resuscitate (do cardiopulmonary resuscitation or CPR on) someone who suffers an out-of-hospital cardiac arrest have been demonstrated to improve the one-year survival of such victims. A just-reported study from Denmark found that over a one-year follow-up after the cardiac arrest, mortality fell from 18 percent down to about 8 percent when bystanders initiated CPR (when no emergency medical services were immediately available). So that's all good. Here's the "but"-the study only looked at one-month survivors of cardiac arrest. Unfortunately, over 90 percent of the cardiac arrest victims had either died, suffered brain damage, or were in nursing homes 30 days after their cardiac arrest and were not included in the study. So, yes, you can make some difference and shouldn't hesitate to perform CPR, but we all need to realize that the benefit is relatively modest. But what an incredible feeling it can be to save a life. I've been fortunate enough to have that experience, and it is very special indeed.
Wynne is vice president for health affairs at UND, dean of the School of Medicine and Health Sciences, and a professor of medicine. He is a cardiologist by training.
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The content of this column is for informational purposes only and does not substitute for professional medical advice or care. The information provided herein should not be used for diagnosing or treating a health problem or disease. If you have or suspect you may have a health problem, you should consult your health care provider. Never disregard professional medical advice or delay in seeking it because of something you have read in this column.