What you need to know about blood lipids and how to control them
High cholesterol levels (hypercholesterolemia) significantly increase the risk of heart attack and stroke. Fortunately, there are currently a number of effective treatment options available.
What types of cholesterol are there?
In the past, the focus was on total cholesterol, but current recommendations concentrate on low-density lipoprotein (LDL) cholesterol. It is often referred to as “bad cholesterol”. Higher levels of LDL cholesterol are associated with an increased risk of heart attack, stroke, the need for stenting or coronary artery bypass surgery, and death. Research conducted over the past 50 years has shown that lowering LDL cholesterol levels leads to a reduction in the frequency of these events.
Another type of cholesterol—triglycerides—is also associated with an increased risk of these adverse events. On the other hand, high-density lipoprotein (HDL) cholesterol is associated with a lower risk of vascular problems.
Cholesterol levels (especially LDL cholesterol and triglycerides) can almost always be reduced through weight loss (diet and exercise) and medication.
As lipid levels decrease, the risk of developing cardiovascular diseases, including damage, is reduced vessels supplying the heart (ischemic heart disease), brain (cerebrovascular diseases), and limbs (peripheral vascular diseases) In addition, the risk of heart attack or stroke is reduced. However, even if you already have cardiovascular disease, it’s never too late to reduce the risk of its progression.
When should cholesterol be checked?
The initial screening profile is often determined by a pediatrician in childhood and should be re-measured at the age of 18. Below are some commonly used recommendations.
● Regular lipid screening should begin at age 40 if there are no other risk factors for cardiovascular diseases.
● Screening should begin earlier if there are factors such as obesity, diabetes, high blood pressure, smoking, or a family history of cardiovascular diseases at a young age.
The optimal time interval between lipid screenings has not been determined. A reasonable approach is to check cholesterol every five years if the lipid profile is normal, and more frequently—every three years—if lipids are approaching the threshold of reference values.
There are no specific recommendations for stopping screening at a certain age. However, it is believed that if a person has a normal lipid profile, the likelihood of increased cholesterol after 65 is low.
How to determine if you need treatment for hypercholesterolemia?
The decision to start treatment to lower cholesterol levels is made individually in each specific case. Doctors consider the current lipid levels, risk of heart attack, presence or absence of cardiovascular diseases, and other risk factors.
What is used to treat “bad” cholesterol?
There are many medications that lower elevated LDL cholesterol levels. Each category of medication differs in how they work and in effectiveness. The doctor selects a drug or their combination based on blood lipid levels and individual factors.
Statins
Statins are one of the most studied classes of drugs and are most commonly used to lower LDL cholesterol levels. They are the most effective drugs for the prevention of ischemic heart disease, heart attack, stroke, and mortality from these diseases. Statins reduce the production of cholesterol in the body and increase the elimination of cholesterol by the liver, lowering LDL cholesterol levels by 25-55% In addition, they lower triglyceride levels.
Although most people tolerate statins well, there are possible side effects, more often muscle pain or weakness. The use of statins may also increase the risk of developing diabetes, although the risk is mainly observed in people with prediabetes, and the benefit in reducing the incidence of heart attack and stroke is approximately four times greater than the risk of developing diabetes.
Ezetimibe
Ezetimibe blocks the body’s ability to actively transport cholesterol from food, as well as the cholesterol that the body produces internally. It reduces LDL cholesterol levels by 20-25% and has relatively few side effects. It is usually prescribed in combination with statins, but it is also used separately in patients who cannot tolerate statins. When used in combination with statins after a heart attack, ezetimibe provides a slight additional reduction in the risk of another cardiovascular event.
Bile acid sequestrants
These medications bind to bile acids in the intestine, reducing the amount of cholesterol absorbed by the body from food. They are rarely used due to their side effects and low effectiveness. They slightly reduce LDL cholesterol levels—by 10 to 15%. Side effects may manifest as nausea, bloating, cramps, and liver damage
In some cases, oral medications are not enough to fully control cholesterol. That’s when injectable forms of medications come to our aid.
Inhibitors PCSK9
Inhibitors PCSK9 — inhibitors PCSK9 represent another class of drugs that lower LDL cholesterol levels. Monoclonal antibody drugs – alirocumab and evolocumab are administered as injections every two to four weeks.
Not long ago, a drug appeared in our country as an alternative to monoclonal antibodies for lowering levels PCSK9-инклисиран.
It is also called the “cholesterol vaccine” because maintenance treatment is administered once every 6 months.
Inclisiran reduces LDL cholesterol levels in the blood by more than 50% and is a small RNA fragment that, after injection, is absorbed by liver cells. Inside the liver cells, it inhibits the production of a protein called PCSK9. Reduction level PCSK9 causes liver cells to remove more LDL cholesterol from the blood
In case of statin intolerance, the drug can be used as monotherapy. According to the instructions, inclisiran injection is administered by a healthcare professional. The drug is injected into the skin of the abdomen, arm, or thigh. The only registered side effects of Inclisiran are mild or moderate reactions at the injection site, including tenderness, redness, and rash.
In May 2023, a patient with familial hypercholesterolemia (FH) visited our clinic. Her low-density lipids level reached 9 mmol/L (normal is below 1.8 for FH diagnosis). Despite high-dose statin therapy, the LDL goal was not achieved, and it was decided together with the patient to start treatment with inclisiran.
Our clinic operates according to international standards of diagnosis and treatment. In the Republic of Bashkortostan, this is the first case of using innovative therapy with a molecule of matrix informational RNA interference. The V.S. Buzaev International Medical Centre implements treatment using the latest technologies and next-generation drugs. The main value of the Centre is a personalized approach to the patient’s problem.
We are transforming medicine!
Nailya Rifatovna Mukhamadeeva, Deputy Chief Medical Officer, Cardiologist, Therapist