High Cholesterol: New Treatments and Research

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Several new approaches to tackling high cholesterol hold promise for people on the path to better heart health. Some researchers research cutting-edge technology while others perfect common therapies that have long been known to support cardiovascular health.

Here are five notable advances in treating high cholesterol.

The American Heart Association has long recommended eating fish as part of a heart-healthy diet. Fish is a source of lean protein and omega-3 fatty acids. Previous studies have shown that three types of omega-3 fatty acids reduce the risk of heart disease and heart attacks:

  • α-linoleic acid (ALA), found in nuts, seeds and vegetable oils (such as olive and rapeseed oil)
  • Eicosapentaenoic Acid (EPA), which is mainly found in fatty fish such as salmon, tuna, halibut, and cod
  • Docosahexaenoic acid (DHA), also found in fish

New research shows that EPA may have particularly significant benefit for people with high triglycerides who are at high risk of cardiovascular disease.

Triglycerides are a type of fat in the blood. High triglyceride levels coupled with high levels of low-density lipoprotein (LDL, the “bad” cholesterol) or low levels of high-density lipoprotein (HDL, the “good” cholesterol) increase the risk of heart attack and stroke.

A 2019 study tracked more than 8,000 people who received statin therapy but still had high levels of triglycerides. The participants were followed for a mean duration of 4.9 years.

Those who took a purified form of EPA (icosapent ethyl, brand name Vascepa) with statins twice a day had a significantly lower risk of heart attack, stroke, and cardiac death.

New drugs show promise in helping the liver to work more efficiently, clearing cholesterol from the blood and reducing the likelihood of a future heart event in people at high risk.

The liver removes excess cholesterol from the bloodstream. The protein proprotein convertase subtilisin / kexin type 9 (PCSK9) is made in the liver and destroys receptors in the liver that remove cholesterol. This prevents the liver from clearing bad cholesterol from the body as efficiently as it normally would.

People with high PCSK9 levels have a tendency to develop high cholesterol and heart disease earlier in life.

A class of drugs called PCSK9 inhibitors destroy these proteins to help the liver do its job. There are two types of PCSK9 inhibitors that are approved for treating high cholesterol and reducing the risk of heart disease:

  • Alirocumab (Praluent)
  • Evolocumab (Repatha)

These injectable drugs are given every two to four weeks. The first injection will usually be given in a doctor’s office.

Recent large, double-blind, placebo-controlled studies of these drugs have shown that they reduce the risk of stroke, heart attack, and cardiovascular death in people with high cholesterol and at high risk of a heart event.

The microbiome is the collection of an estimated 100 trillion bacteria, fungi and viruses that occur naturally in the human body. While these microorganisms live primarily in the gastrointestinal tract, they affect a person’s overall health.

Probiotics are microorganisms in the foods we eat that are very similar to the healthy bacteria that grow in the gut.

Previous research has found that taking a probiotic supplement can lower LDL cholesterol and improve a person’s LDL to HDL ratio. It may have other heart health benefits including lowering blood pressure, inflammatory mediators, blood sugar levels, and body mass index.

A 2018 analysis of 32 clinical trials specifically looking at the effects of probiotics on total cholesterol found them to be effective when compared to placebo. The results were more significant for people who had higher baseline total cholesterol and were receiving long-term probiotic therapy.

More research needs to be done to understand how probiotics benefit the heart system, which probiotic strains are most effective, and whether a person’s genetics affect the effectiveness of these supplements.

Familial hypercholesterolemia (FH) is a high level of cholesterol caused by an inherited genetic mutation. There are two types of UAS:

  • Heterozygous FH. This is the case when a person inherits an FH gene from one parent and a normal gene from the other parent. It affects about 1 in 200 to 244 people.
  • Homozygous FH. In this case, a person inherits two FH genes, one from each parent. It affects about 1 in 160,000 to 300,000 people.

Both conditions are characterized by very high LDL cholesterol levels and an increased risk of premature cardiovascular disease. However, symptoms of homozygous FH tend to come on earlier and the condition progresses faster.

A 2014 review concluded that untreated homozygous FH leads to plaque buildup in the arteries known as atherosclerosis and a life expectancy of 30 years by the age of 20. Doctors aim to treat high cholesterol early and detect complications in people with the condition.

A new drug evinacumab (Evkeeza) offers new hope to people with homozygous FH. A small clinical study published in 2020 found that a monthly infusion of evinacumab reduced LDL cholesterol levels by 49 percent after 24 weeks.

In February 2021, the Food & Drug Administration (FDA) approved evinacumab for people 12 years of age and older with homozygous FH.

This medication is given as an intravenous infusion once a month. Research has not yet proven its safety and effectiveness in treating high cholesterol for other reasons.

Pregnancy tests are recommended for people who can become pregnant before starting this medication.

PCSK9 inhibitors are powerful tools in the fight against high cholesterol. Perhaps unsurprisingly, researchers are looking for new ways to prevent PCSK9 proteins from affecting the liver’s cholesterol-lowering effects.

One such innovation is small interfering therapy (siRNA), Inclisiran (Leqvio). This biological drug regulates the expression of target genes to lower a person’s PCSK9 levels.

Three recent studies have shown high efficacy of this drug in people at high risk for cardiovascular disease or familial hypercholesterolemia, according to an article published in 2020.

Participants who received inclisiran therapy every 6 months saw a 50 percent decrease in their LDL cholesterol.

Inclisiran was approved for use in the European Union through December 2020. That same month, the FDA denied approval of the drug in the United States after discovering problems with a European manufacturing facility. Manufacturers are working to solve the problem and get FDA approval.

Nanotechnology is the study and use of very small things. Nanomedicine uses nanotechnology, or very small materials, to diagnose, monitor, control, prevent and treat diseases.

These technologies can help meet unmet medical needs. They can help target a drug to specific areas in the body so that it is effective at a lower dose with fewer undesirable side effects.

For example, nanomedicine is often used in CT or MRI scans to highlight certain parts of the body when imaging. It is also widely used for targeted cancer treatments.

Researchers are also exploring the uses of nanotechnology to diagnose and treat high cholesterol. For example, some nanodrugs could inhibit the expression of genes that are responsible for regulating cholesterol.

A 2017 study reviewed these approaches. Some of these approaches, such as Inhibitors, such as PCSK9, have already been shown to be safe and effective and are currently FDA approved for the treatment of high cholesterol. Others are still in development.

An exciting development is the use of nanoparticles that mimic HDL, or “good” cholesterol. Researchers are investigating the use of HDL-mimicking nanoparticles to better target drug therapies like statins and improve diagnostic imaging.

A 2020 paper indicated that future developments may not only deliver statins, but also novel RNAs, proteins, and DNAs.

In 2020, researchers at Stanford Medical School used nanotechnology to significantly rid mice of arterial plaque with few side effects. In the study, the scientists made nanotubes that were taken up by white blood cells and transported a molecule into the arteries. The molecule switched off the signal in plaque cells that tells the immune system not to delete it.

The researchers called it the “don’t eat me” signal, the same mechanism that can allow cancer cells to escape destruction by the immune system. Once this signal was turned off, the immune system was able to remove the unhealthy cells.

The study showed a 40 percent reduction in female and male mice with less advanced plaque and a 20 percent reduction in male mice with more advanced plaque. The Stanford researchers’ approach allowed healthy cells to remain intact while the diseased cells were removed from the body.

These options provide an insight into the new opportunities that may exist for future cholesterol treatment.

Researchers are developing new therapies that work alongside established cholesterol treatments such as statins. These show promise for people with difficult-to-manage cholesterol levels, such as: B. People with familial hypercholesterolemia.

Some therapies like fish oil and probiotics are available to many people who want to support heart health.

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