The future of cholesterol control

Statins will soon have a lot more competition, with new drugs, a vaccine and even gene editing on the horizon.

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Treatment options are expanding rapidly for high cholesterol patients, says today’s guest on The Tea Room.

Professor Steve Nicholls, director of the new Victorian Heart Hospital, shares the latest in clinical trials and reveals a possible heart disease vaccine.

“There’s an approach now, in clinical trials, that uses fairly old-fashioned vaccine technology but instead of trying to go after some antimicrobial target, the vaccine is simply targeting (a cholesterol-inducing protein) PCSK9,” he says.

He says that research advances are coming at cholesterol treatment from all angles. There are novel ways to tackle lipoprotein(a) and triglycerides, a new approach to high-density lipoproteins, and other injectables and oral agents that by themselves, or in combination with other therapies, will lower LDL cholesterol by 50%.

“And then at the very end of all of this is gene editing and the idea that we may be able to have once-in-a-lifetime treatment for cholesterol. All of these approaches are now real and are undergoing clinical development,” Professor Nicholls says.

Professor Nicholls also discusses the nocebo effect of stains and says that half of the patients who are prescribed stains will stop taking the drug within 12 to 18 months.

“We know that statin intolerance is a really big deal,” he says adding that there is new hope for those patients.

“We’ve just reported a really large clinical trial of a new agent called bempedoic acid, and that not only lowered cholesterol, but lowered the risk of heart attack, stroke, and death,” he says.

Professor Nicholls also analyses the pros and cons of the Victorian Heart Hospital that his team opened four weeks ago.

“It’s been great to watch individual medical departments working together to think differently about the way we treat multi-system disease and provide great care for that. To watch that start to come to life is pretty exciting,” he says.

You can listen and subscribe to the show by searching for “The Tea Room Medical Republic” in your favourite podcast player.