Has your doctor told you that your cholesterol levels are high? If so, you may have been started on a statin. That's usually the first line of treatment. But sometimes that medication alone isn't enough. Or some people can't tolerate the side effects of the medication. That's why doctors are now talking about a new class of drugs that are a 'game-changer'. These are called PCSK9 Inhibitors. Let's talk about them in simple terms today.
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Simply put, what are these PCSK9 Inhibitors?
These are a new class of drugs that can very effectively reduce the 'bad' cholesterol, or LDL cholesterol , in our blood. There are currently two main types of drugs approved in the world. They are alirocumab (Praluent) and evolocumab (Repatha).
Research has shown that these drugs, called PCSK9 inhibitors, are surprisingly effective. In some cases, they can even prevent heart attacks and strokes . These drugs can be taken alone, or in combination with a statin drug you already take. But one thing to keep in mind is that they are much more expensive than other cholesterol drugs.
Okay, now let's see how this medicine works inside the body.
To understand this, let's think of a little story. The main organ that controls cholesterol in our body is the liver.
Imagine that our liver cells have little "scavengers" (receptors) that capture and remove unwanted cholesterol from the blood. These are the ones who keep our blood vessels clean.
But, there's another protein called PCSK9 that our bodies produce. Its job is to find and destroy those good "cleaners." Then, because there's no one to remove the cholesterol, it builds up in the blood and gets deposited in the walls of the arteries.
This is where our speaker, the PCSK9 inhibitor drug, comes to the rescue. What this drug does is it grabs that bad PCSK9 protein and stops it from working. It's like grabbing a naughty child and putting him in a chair. Then our "cleaners" can do their job without any hindrance. The result? The level of LDL cholesterol in the blood decreases rapidly.
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Check Availability →How are these different from 'statins'?
Statins and PCSK9 inhibitors are two types of drugs that lower cholesterol, but they work in two different ways. This table will help you understand this.
| Difference | Statin | PCSK9 Inhibitors |
|---|---|---|
| Functionality | Prevents the production of cholesterol in the liver. | Prevents the destruction of receptors that remove cholesterol from the liver. |
| How to take | A pill taken daily. | An injection given every 2 or 4 weeks. |
| Usage | Often used alone, it is the first choice for cholesterol control. | It can be used alone or in combination with statins. The results are even stronger. |
So who wants to take this medicine?
This is an important question because not everyone with high cholesterol needs this medication. Your doctor will first try to control your cholesterol with statins. But your doctor may consider a PCSK9 inhibitor in the following cases:
- Genetic high cholesterol conditions: Some people have a genetic condition called Familial Hypercholesterolemia.'' These people have a defect in the way their body controls cholesterol. Even with the maximum dose of statins, it is very difficult for these people to bring LDL cholesterol down to a healthy level.
- For people at very high risk of heart attack or stroke: If you already have heart disease, and your cholesterol levels are not adequately controlled with medications like statins, your doctor may consider this medication.
- For those who can't tolerate 'statins': About 10%-20% of people who take statins experience side effects like unbearable muscle pain, weakness, and body aches . For those people, this may be a good option.
When does the doctor give this medicine?
A doctor would never give this medicine all at once. There is a procedure for it.
1. First, change your lifestyle: The doctor first says to exercise well and eat healthy foods that are low in oil, sugar, and flour .
2. Next, a 'Statin': If lifestyle changes are not enough, a statin is started. If cholesterol does not go down, the dose is gradually increased.
3. As a last resort: If your cholesterol is not controlled even with the maximum dose of statins, or if the side effects are severe, then your doctor may consider a PCSK9 inhibitor. This decision may be made by performing a test, such as a coronary calcium score, to assess your risk of heart disease.
How is this medicine used and what are the side effects?
It comes as a subcutaneous injection that you give under the skin every two or four weeks . You can get it in the skin of your stomach, upper thigh, or upper arm. Your doctor or a trained nurse will show you how to give it properly. It's usually painless and easy.
When it comes to side effects, the most common ones are minor.
- Backache
- Cold-like symptoms (itchy throat, mucus production)
- Redness, bruising, or slight pain at the injection site
Very important: Rarely, severe allergic reactions can occur. If you suddenly develop severe hives, swelling of the face or lips, or difficulty breathing , this is an emergency. If this happens, you should go to the nearest hospital emergency department (ETU) immediately .
Finally, when it comes to the cost of these medications, they are not like regular medications, and are very expensive . Therefore, this treatment may not be affordable for everyone. It is best to talk openly with your doctor about this and discuss whether you need it, whether it is right for you, and what your cost options are.
💡 Take-Home Message
- PCSK9 inhibitors are a very powerful, new class of drugs that lower high LDL ('bad') cholesterol levels.
- These do not come as pills to take daily, but as an injection given every 2 or 4 weeks.
- These are usually recommended for people with genetic cholesterol disorders, those at very high risk of heart disease, or those who cannot tolerate statin medications.
- This medication is very expensive, so you should decide whether this is right for you after careful discussion with your doctor.
- Never make decisions about medications based on hearsay or what you see on the internet. Always follow your doctor's advice.
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