Patients taking statins now have two alternative cholesterol medicines to choose from. But are they suitable for everyone? Asst Prof Jack Tan, Deputy Head and Senior Consultant, Department of Cardiology, National Heart Centre Singapore (NHCS), answers.
Continued from a previous page.
Currently, National Heart Centre Singapore (NHCS),
a member of the
SingHealth group, has 20 patients on either one of the two new cholesterol medicines – alirocumab and evolocumab. They are those at high risk of a heart attack, who cannot tolerate high-dose statins, or have not been able to reach their target LDL cholesterol (low-density lipoprotein) levels.
Alirocumab is prescribed in two doses (no difference in price), and evolocumab in a standard dose. Both are taken once a fortnight through subcutaneous injections.
Preferred way to take new cholesterol medicines
Except for patients who cannot tolerate statins,
Asst Prof Jack Tan, Deputy Head and Senior Consultant,
Department of Cardiology, NHCS, said
the preferred way to use both drugs is in combination with a statin, because they complement statins and produce better results when paired up.
When LDL cholesterol levels are too high even with statins
The new cholesterol medicines are also given to people with an inherited condition called
homozygous familial hypercholesterolemia, where LDL cholesterol is so high that even the strongest doses of statins cannot reduce it to target levels.
One in 300 to 500 people have this condition in the milder heterozygous form. “From young, their baseline cholesterol is very high. So they have heart attacks earlier in life. If their condition is more severe, they can have heart attacks as young as in their 20s because their cholesterol is sky-high,” said Asst Prof Tan.
What to consider when taking new cholesterol medicines
The two main considerations patients have regarding the two new drugs are:
- Cost, and the
- Drugs have to be injected, which some find off-putting, although the jabs are convenient and almost painless
One month’s treatment with alirocumab or evolocumab is about $600 at NHCS, as subsidies are not available for these non-standard drugs. Comparatively, the high dose of the generic statin, atorvastatin, costs $18 per month before subsidy, and $4.50 on a 75 per cent subsidy.
Are there side effects to taking statins? How can you lower your LDL cholesterol without having to take medication? See the
previous page to find out.