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Ask the Pharmacist: New treatment approach to high cholesterol

Suzy Cohen
Columnist
There's a new treatment approach to high cholesterol

For years we have heard that statins are the gold standard pharmacological treatment for high cholesterol. But there’s more to the story because those drugs, introduced in the 1980s when I was a young pharmacist, do not sweep out the cholesterol in your blood vessels. They only block endogenous production by your body, and in doing so, they can lead to devastating side effects due to the drug mugging effect of ubiquinol, the activated form of CoQ10.

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But first I’d like to make sure you know my stance on cholesterol. I don’t think it’s bad at all, however, the ratios need to be in a healthy balance. It is not cholesterol itself that leads to heart attacks… it couldn’t be or we’d all be dead. It’s more the imbalanced ratio of certain particles. There are many particles of cholesterol, but the two most famous ones are LDL and HDL. Keeping this superbly simple, you want to keep the HDL level high, and reduce the amount of LDL.  

Even though I prefer natural approaches to medical problems, as a pharmacist I can offer you my perspective on a new therapeutic option for high cholesterol.  I’m referring to a new category of medications called PCSK9 inhibitors.

The PCSK9 are a new class of LDL-lowering medications, and they are given by self-injection, every two weeks.

There's a new treatment approach to high cholesterol

You as a human being carry a gene called “PCSK9” which stands for “proprotein convertase subtilisin/kexin type 9.” The PCSK9 gene provides the blueprint for your body to build a protein also abbreviated as PCSK9. This protein regulates the amount of cholesterol that floats around in your bloodstream. The drugs inhibit PCSK9 and so they work by improving your liver's ability to remove cholesterol from the blood. They do this by inhibiting PCSK9 which prevents destruction of LDL receptors on your cells.

There are two medications in this category: Praluent (chemical name: Alirocumab); Repatha (chemical name: Evolocumab). 

See the names here, they both end in “cumab” so since it’s easier for the sake of reading my article, I will refer to this category of drugs as cumab drugs, or the cumabs. That’s not an official nickname, it’s just for reading ease and I’ve made it up!

The cumab drugs reduce LDL cholesterol by about 60 percent which in turn could reduce risk of heart attack, chest pain, unstable angina, and stroke by up to 15 percent. Cumabs are stronger than statins. They do not interfere with CoQ10 like the statins, because the cumabs reduce LDL cholesterol at the level of the receptor site, not by inhibiting production. Please also evaluate homocysteine levels, CRP, Lp(a) and blood pressure. Finally, age and hormone status matters. Insufficient levels of DHEA, estrogen and testosterone all affect your cardiovascular system. If this topic interests you, please subscribe to my newsletter at suzycohen.com, and I will email you a longer version of this article.

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Suzy Cohen is a registered pharmacist. The information presented here is not intended to treat, cure or diagnose any condition. Visit SuzyCohen.com.