Reducing LDL

Thursday, September 21, I went to a Nurse Practitioner Network dinner that was sponsored by Sanofi, the drug company responsible for Praluent (alirocumab). Praluent in an injectable drug that lowers LDL, a specific type of cholesterol. The lecture was given by Dr. Allen Taylor, who is a cardiologist that works to treat and prevent cardiology patients from adverse events.
First, let’s start from the beginning. What is cholesterol? Cholesterol is a waxy substance located in the bloodstream. There are three types of cholesterol- LDL, HDL, and triglycerides. LDL is short for low density lipids. LDL is also known as “bad cholesterol” because it is associated with strokes, heart attack, plaque buildup in the arteries, and heart disease. HDL is short for high density lipids. HDL is also known as “good cholesterol” because it lowers the risk for plaque buildup, stroke, heart attack, and heart disease. Triglycerides are a type of cholesterol linked to sugar intake and fat storage. The total of these three numbers is what most patients know as their cholesterol level. Cholesterol can come from diet (example: animal fats) but it is also produced in the liver. We always hear of cholesterol in negative terms, however, it is important to know that the body uses a certain amount of cholesterol to function. But, as the saying goes, too much of a good thing isn’t good, and cholesterol is no exception. Once the cholesterol levels reach a certain point, it can lead to diseases.
The point that Dr. Taylor stressed during his lecture was that our patients should strive for an LDL under 70. While some patients can achieve this with diet and exercise, others may need a medication. Rarely, patients may have what is known as heterozygous familial hypercholesterolemia, which means it is an inherited condition. When diet and exercise are not sufficient, patients may need to be placed on a statin drug. Currently, Crestor is the most potent statin drug, showing a 46.3% reduction in LDL.
Sanofi developed a drug called Praluent that is a once or twice monthly injectable medication that specifically reduces LDL, the type of cholesterol most associated with cardiovascular diseases. Praluent works by targeting a naturally occurring protein in the blood called PCSK9. PCSK9 is responsible for destroying the LDL receptors (the things that take the LDL out of the bloodstream). Praluent is an antibody, meaning the body recognizes it as a natural chemical. The medication, during their 24 week trial, was able to get 83% of patients to their targeted LDL (<70).
Although Praluent works effectively, not everyone is eligible at this time. Currently, the drug is being approved for patients who are already on the highest amount of a statin drug with established heart and vascular disease or an increased familial history with very high LDL. It also may be indicated for patients who have these conditions and are unable to tolerate a statin medication. A prior authorization may also be indicated.
I enjoyed hearing Dr. Taylor speak on Thursday and I was able to learn, not only about a new drug, but also about the goals for cholesterol therapy. It is helpful to be able to interact with a specialist and ask specific questions that enable me to treat my patients more effectively. I look forward to attending more lectures in the future and sharing my experiences in the PCPG blog.