Nov
09
2024

Vital Information about Cholesterol Drugs

By | cholesterol, heart attack, Stroke

Most people know about statins to treat high cholesterol, but they do not have vital information about cholesterol drugs. Recently an article appeared in CNN, which was very informative. In the following I will review what is new about cholesterol lowering drugs.

PCSK9 inhibitors, which are monoclonal antibodies

Sarah Lewis is a pharmacist and medical writer with over 25 years of experience in various areas of pharmacy practice. She explained that there are injectable cholesterol lowering drugs for use when traditional statins are not powerful enough to lower cholesterol levels. But these injectable drugs are very expensive and payment agencies demand fulfillment of strict criteria before they approve these drugs. The new injectable drug, which the FDA approved in 2015 is an PCSK9 inhibitor. It has the name alirocumab (Praluent) and is a monoclonal antibody. PCSK9 is a natural liver protein that regulates how many LDL receptors you have. Alirocumab reduces LDL receptors, which lowers LDL cholesterol levels. Several months later the FDA approved a second PCSK9 inhibitor, evolocumab (brand name: Repatha).

Side effects of statins and PCSK9 inhibitors

Statins are the gold standard for treating high cholesterol. They work by inhibiting an enzyme that controls how much cholesterol your body makes. But many people have significant side-effects from statins.

There can be side effects in the form of muscle pain. But statins can also cause headaches or dizziness. Others are feeling sick from statins, get unusually tired or develop a physical weakness.

These people often must lower their dose. Alternatively, their doctor switches them to a different statin in order to carry on therapy. PCSK9 inhibitors have none of these side-effects. The main side effect of PCSK9 inhibitors are injection site reactions, flu-like symptoms, and allergic reactions. They can be severe. Overall, there is a better tolerability of PCSK9 inhibitors than with statins. Unfortunately, the cost is around $12,000 to $14,000 per year for PCSK9 inhibitor therapy, which is very difficult to justify. Another disadvantage is that the patient has to self-inject the PCSK9 inhibitor.

PCSK9 inhibitors are added in specific patients

Because of the costs of PCSK9 inhibitor statins are still the first line of therapy in patients with high cholesterol. But there are patients who have familial hypercholesterolemia, which is an inherited condition. The physician treats them first with statins such as atorvastatin (Lipitor) or rosuvastatin (Crestor). The physician pushes the dosage to the maximal dosage. Often in these cases of inherited high cholesterol the new PCSK9 inhibitor drugs have to be added as a second line of therapy.

Patients with hardening of the arteries and a history of a heart attack or a stroke need aggressive cholesterol lowering treatment. These patients require both PCSK9 inhibitors and statin therapy.

Rigid rules from insurance companies

Because of the expense of PCSK9 inhibitors insurance companies have established the following rules.

  • You have to have either familial hypercholesterolemia or a history of a heart attack or stroke.
  • You must see a dietician for comprehensive dietary counseling.
  • You are on the maximum dose of a statin or you can tolerate only a lower dose of a statin because of side effects.

Only when these criteria are fulfilled does the insurance company consider to authorize an addition of a PCSK9 inhibitor to the statin treatment.

Vital Information about Cholesterol Drugs

Vital Information about Cholesterol Drugs

Conclusion

Traditional statin therapy for high cholesterol levels is the gold standard for treating high cholesterol. Statins work by inhibiting an enzyme that controls how much cholesterol your body makes. Unfortunately, statins can have a number of side effects like muscle cramps and fatigue. A new type of cholesterol lowering drug was authorized by the FDA in 2015. This new drug has the name alirocumab (Praluent) and is a monoclonal antibody. PCSK9 is a natural liver protein that regulates how many LDL receptors you have. Alirocumab reduces LDL receptors, which lowers LDL cholesterol levels. It has much less side effects than the statins, but costs are around $12,000 to $14,000 per year, which is very difficult to justify.

How physicians prescribe the new drugs

The new PCSK9 inhibitor drugs are prescribed as an add-on to statin therapy to lower cholesterol. Physicians prescribe this to patients who have a familial hypercholesterolemia and to patients who had a heart attack or a stroke. One inconvenience of these new cholesterol lowering agents is that the patient has to inject it rather than take it as a tablet by mouth. Studies showed that PCSK9 inhibitors have a favorable cholesterol lowering effect. Alirocumab (Praluent) lowered cholesterol between 36 to 59%. The newer evolocumab (Repatha), lowered LDL by 60%. Both drugs showed a risk reduction of cardiovascular events by 50%, which helps long-term survival of patients with cardiovascular disease. PCSK9 inhibitor drugs are powerful cholesterol lowering agents. However, at the present time the cost of this treatment is too expensive.

Jul
01
2007

Waist line reduction scores in health prevention

By | Health, Hormones, Men's Health, Nutrition, Obesity, Prevention

To women waist measurement has always been of importance. Increased waist measurement and weight gain go hand in hand, and a poor fitting garment in the waist usually signals to cut out the junk food. In the past century extremely tiny waists became an unhealthy obsession, till common sense got the upper hand.

In the past males seemed to be unperturbed by a large girth and often ridiculed the opposite sex about their preoccupation with their waist lines. With more knowledge about the intricate play of metabolism increased waist circumference is a signal to health problems. It may be that a simple measuring tape can be one of the most helpful tools to predict a group of health problems in males. While type 2 diabetes, hypertension and high cholesterol and triglycerides are the problems that would first come to mind, there are more, namely coronary artery disease, prostate enlargement, a high prostate-specific antigen level, erectile dysfunction and ejaculatory dysfunction. Dr. Steven Kaplan, professor of urology at Cornell University, New York presented a study at the American Urological Association. Men with moderate to severe urinary tract symptoms were divided into groups based on their waist sizes, 30 to 36 inches, 36 to 40 inches and greater than 40 inches.

Waist line reduction scores in health prevention

Waist line reduction scores in health prevention

Results surprised even the researchers. Metabolic disorders like diabetes showed an incidence of 11.25% in the first group, 22.3 % in the next higher group and 37.8% in the group with waistlines over 40 inches. Erectile dysfunction was seen in 34.6%, 49.5% and 78.6 % respectively. The percentiles for hypertension showed 12.6% in the first group, versus 24.7% and 37.8 %. The researchers stressed that male pelvic dysfunction and the derailment of metabolic function, also known as the “metabolic syndrome” are closely linked.

More information about metabolic syndrome: http://nethealthbook.com/hormones/metabolic-syndrome/

Last edited November 2, 2014

Dec
01
2006

Cinnamon And Multivitamins May Boost Fertility

By | Health, Nutrition, obstetrics, Vitamins and supplements, Women’s Diseases

Prenatal vitamin supplements are the norm, as folic acid has been known to play a role in the prevention of neural tube defect. Generally they are taken once pregnancy has been confirmed.
Dr Jorge Chavarro from the department of nutrition at the Harvard School of Public Health in Boston pointed out, that multivitamin supplementation has its place earlier than just after the pregnancy test has become positive. In one of the largest studies involving 18,000 married pre-menopausal women, regular use of multivitamin supplements were associated with a decrease of infertility. The key is in the regular use. Women who took two multivitamin tablets per week had similar infertility rates as women who did not take supplements at all. Those who took 6 or more multivitamins had a 40% lower risk of anovultation, a condition where no eggs are released by the ovaries.
Most of the women were Caucasian between the ages 24 and 42.
The importance of nutrition is coming increasingly into the forefront in reproductive medicine. One condition known as polycystic ovary syndrome (PCOS) is often a reason for infertility. It is one of the red flags that point to the condition of insulin resistance, and it manifests itself in menstrual irregularity and higher levels of androgens, often showing as increased facial hair. As the metabolism is headed for trouble, diabetes, high blood pressure, high cholesterol and heart disease would tend to develop.
Researchers at Columbia University in New York conducted a pilot study to see if insulin sensitivity in women with PCOS could be improved. Cinnamon, a well-known spice, has been known to have a favorable effect on the insulin response of the body. Researchers found that eight weeks of treatment with cinnamon extract significantly decreased fasting glucose and insulin resistance in women with polycystic ovary syndrome.

Cinnamon And Multivitamins May Boost Fertility

Cinnamon And Multivitamins May Boost Fertility

Dr. Jeff Wang who conducted the study reported that no side effects or adverse reactions were reported throughout the study period. If large-scale prospective studies confirm these findings, then recommending cinnamon as a dietary factor may be a simple, inexpensive lifestyle change that can be easily followed. Reducing insulin resistance is a key to improve the overall health status in patients with PCOS, and it ties in with reproductive health benefits as well.

More information about infertility: http://nethealthbook.com/womens-health-gynecology-and-obstetrics/infertility-php/

Reference: The Medical Post, November 14, 2006, page 32

Last edited November 2, 2014

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Aug
01
2004

Too Much Fat Fuels Metabolic Syndrome

By | Heart Disease, High Blood Pressure, Hormones, Nutrition, Obesity

In a review article for physicians from the St. Michael’s Hospital of the University of Toronto (see reference below) Dr. Monge outlined some of the newer human research where links were found between the lining of the blood vessels and the hormones produced by fat cells that lead to the complications of the metabolic syndrome. In obese people there is a cluster of conditions such as high blood pressure, high blood sugar, high cholesterol, lipid abnormalities and high insulin levels, which is known as “metabolic syndrome”. Another name that was used for this condition in the 1990’s was “syndrome of insulin resistance”.

Dr. Monge pointed out that blood vessel health depends on the fine balance between two opposing forces. On the one hand there is a system that leads to blood vessel spasm, blood clotting, growth promoting, inflammation causing and oxidizing. On the other hand there is a system that is responsible for blood vessel relaxation, growth inhibition, blood clot dissolving, inhibiting inflammation and antioxidant activity. Complex changes occur in our metabolism when we put on pounds and accumulate too much fat. It is important to realize that fat is not just sitting there, but is composed of highly active fat cells that respond to insulin and growth factors and in turn produce a number of hormones and factors that affect the cells that are lining the blood vessels. Inflammatory cytokines are produced by fat cells that attack the blood vessels by producing atheromatous plaques, causing them to accumulate fat again and help in the processes that lead to rupture of the plaques.

Too Much Fat Fuels Metabolic Syndrome

Too Much Fat Fuels Metabolic Syndrome

The end result is that the deadly interplay between the fat cells and the endothelial cells lining the blood vessels tips the balance between the two systems mentioned above to the point where heart attacks and strokes suddenly occur.

There are two complex pathways that are involved in this process and that are linked to what was stated above. One crucial aspect of this involves nitric oxide, a small molecule that is normally produced by the endothelial lining cells and that is needed for normal circulation of the heart muscle, skeletal muscles and internal organs. This protective system is where much of the derangement of normal metabolism occurs with regard to the metabolic syndrome.

Dr. Monge pointed out that with these newer insights into the complex metabolic changes associated with the metabolic syndrome in obese people, there will be very practical results in the near future. Anti-inflammatory medications are already being utilized and some of the anti-diabetic medications have been shown to reduce the risk of heart attacks. It is hoped that sensitive tests will be developed to measure the hidden endothelial dysfunction at a time when preventative steps are still effective or early intervention can be done.

More info on the metabolic syndrome: http://nethealthbook.com/hormones/metabolic-syndrome/

Reference: Metabolic Syndrome Rounds (April 2004): J.C. Monge “Endothelial Dysfunction and the metabolic syndrome”

Last edited Oct. 26, 2014

Oct
18
2002

Work Stress Is A Killer…More Than 2-Fold Over A Period Of 25 Years

By | Diabetes, Heart Disease, Obesity, Stroke

In mid October 2002 the British Medical Journal(BMJ 2002;325:p.857-860) published a paper by Dr. Mika Kivimäki from the University of Helsinki where 812 healthy factory workers were followed for about 25 years. The issue was whether stress from work would have negative consequences, which could be measured in terms of cardiovascular disease. Various risk groups were defined from low stress to high stress.

Low stress jobs were classified as people who often had more training, more responsibilities, better salaries, physically less strenuous jobs with more job security. High stress jobs involved the opposite(high demand/low job control/low salary/no job security). Depending on which subgroups of high versus low risks were compared, the investigators found a 2.2 to 2.4-fold increase of strokes and heart attacks due to cardiovascular disease.The team measured other cardiovascular risk factors. They found a significant increase of cholesterol in the high stress job group after 5 years. After 10 years there was a marked weight gain in the stressed group with obesity becoming much more frequent. The authors noted that this likely led to a change of metabolism in the sense of hyperinsulinism, which is known to cause high cholesterol levels and leads to hardening of the arteries with heart attacks and strokes.

Work Stress Is A Killer...More Than 2-Fold Over A Period Of 25 Years

Work Stress Is A Killer…More Than 2-Fold Over A Period Of 25 Years

Visit these useful related links to chapters of my free Internet based Nethealthbook:
Hyperinsulinism or syndrome of insulin resistance:
http://www.nethealthbook.com/articles/hormonalproblems_diabetesmellitus.php

Heart disease:
http://www.nethealthbook.com/articles/cardiovasculardisease_heartdisease.php

Stroke:
http://nethealthbook.com/cardiovascular-disease/stroke-and-brain-aneurysm/hemorrhagic-stroke/

Last edited October 25, 2014