And that's why researchers at Baylor College of Medicine (BCM) are looking into alternate cholesterol-lowering therapies for those for whom statins are not the answer.
Dr. Christie Ballantyne is section chief of cardiology and cardiovascular research at BCM.
"Some people have hereditary disorders and have extremely high LDLs. And so the statin has some efficacy but not enough to get them down as low as they'd like. Then some people have less response than others, and we don't understand all of that. Some of that may be genetic. And it turns out there's an even probably larger group of people that have a hard time taking a high dose of a statin."
Even though statins are safe for most people, there are those that can't take them because they experience side effects.
"Many people complain of some muscle pain, soreness, weakness, excessive fatigability. There's some slight increase in diabetes also. That can occur with high dose statins, and some people [who] say that they may have problems with their nerves or cognition."
With those folks in mind, Dr. Ballantyne says research is underway on an LDL – reduction therapy that is genetic. He says it began with a family with very high, bad cholesterol who was found to have a genetic defect called PCSK9. It made a protein that worked too well and that lead to an increase in LDL. But then another PCSK9 variant was found in some people in which the PCSK9 did not work well, and they had lower LDL.
"And they have more LDL receptors and very low LDL cholesterol. And they were protected from heart disease."
And then the light bulb went off.
"And so the genetics suggested: 'Aha. If you make too much of it, you get a high LDL. If you don't make much of it, you get a low LDL.' So the thought was we can make antibodies to this receptor, and it will block the function. And sure enough, giving a shot lowered LDL 50-to-60 percent."
And so now a number of studies are being conducted in which people get an injection of the antibody to see how and if it can be used on a wider audience.
Two other studies are also underway that involve a certain protein, CETP, which works to transfer and regulate both LDL, bad cholesterol, and HDL, good cholesterol. However, when CETP's function is increased there's also an increased risk of cardiovascular disease.
These two studies are looking at a CETP inhibitor that has been shown to increase HDL while lowering LDL. One study is underway, and the other is just now enrolling people.
Dr. Ballantyne says, though, the most important and first line of defense against heart disease is not drugs, but a healthier lifestyle.
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