'Huge advance' in fighting world's biggest killer

[helvella]

Is hypocholesterolaemia the goal? Looks like it is (see last sentence of my quoted piece).

I wonder what Malcolm Kendrick's view will be?

Could it ever be sensible to prescribe any form of cholesterol-lowering agent without first having properly investigated the possibility of a thyroid disorder?

"… millions of people take drugs called statins …" because they have been prescribed by their doctor. I was offered, nay, pushed towards taking statins. My cholesterol, when tested, has never been high and on last test was low.

'Huge advance' in fighting world's biggest killer

By James Gallagher Health and science reporter, BBC News website

An innovative new drug can prevent heart attacks and strokes by cutting bad cholesterol to unprecedented levels, say doctors.

The results of the large international trial on 27,000 patients means the drug could soon be used by millions.

The British Heart Foundation said the findings were a significant advance in fighting the biggest killer in the world.

Around 15 million people die each year from heart attacks or stroke.

Bad cholesterol is the villain in heart world - it leads to blood vessels furring up, becoming easy to block which fatally starves the heart or brain of oxygen.

It is why millions of people take drugs called statins to reduce the amount of bad cholesterol.

The new drug - evolocumab - changes the way the liver works to also cut bad cholesterol.

"It is much more effective than statins," said Prof Peter Sever, from Imperial College London.

He organised the bit of the trial taking place in the UK with funding from the drug company Amgen.

Prof Sever told the BBC News website: "The end result was cholesterol levels came down and down and down and we've seen cholesterol levels lower than we have ever seen before in the practice of medicine."

More at this link:

bbc.co.uk/news/health-39305640

NICE guidance - currently as of 2016.

nice.org.uk/guidance/ta394

[bluebug]

That f***er "bad cholesterol" again.

Sorry have been watching and reading stuff again (some of it on repeat) about f****** "bad cholesterol" It seems every doctor that sticks their head above the pulpit and points out that this is a damn myth gets taken apart by the statins lobby.

[helvella in reply to bluebug]

It is as if even a single molecule of "bad" cholesterol is absolutely, 100%, irretrievably bad. No hope of reform. Send it to the gallows.

(At worst, it is high levels that might be not so wonderful.)

[DellFinium]

Madness. Thanks for posting this.

[humanbean]

I think this is old news being recycled and re-spun. Dr Kendrick wrote about evolocumab back in 2015.

drmalcolmkendrick.org/2015/...

Evolocumab has had quite a few mentions on Dr Kendrick's site.

[helvella in reply to humanbean]

It is that a major trial has been published. That was why the NICE guidelines were interim.

[helvella in reply to humanbean]

And I now read that again, for I had already read it, I am not surprised.

[BadHare]

I'd class the world's biggest killer as the cr*p that people put in & on their bodies!

[bluebug in reply to BadHare]

The solution is here. theguardian.com/society/201...

Apparently you need to do 6 hours exercise a day and not eat processed foods with sugar.

Though the Lancet doesn't mention 6 hours of exercise just plenty - thelancet.com/journals/lanc...

Oh and not having first world sanitation and health care the diseases and infections they catch probably kill them....

[TSH110 in reply to bluebug]

bluebug well at least I am ok on the 6 hours excercise a day perhaps it will marginally offset the sweet coffee I seem to need to power me through the physical ordeals of the day!

[Justiina]

If all doctors take it first.

[Justiina]

Clinical trials have been very good. Only 69 % has side effects. Sigh. Last sentence is my favourite.

healthline.com/health/pcsk9...

All medications have the potential for side effects. Adverse events were reported in 69 percent of people taking evolocumab in the clinical trials. Injection-site swelling or rash, limb pain, and fatigue were some of the reported side effects. Less than 1 percent reported mental confusion, difficulty focusing, or other neurocognitive issues.

In the alirocumab trials, adverse events were reported in 81 percent of participants taking the drug. These included injection-site reactions, muscle pain, and eye-related events. Slightly more than 1 percent of participants reported neurocognitive adverse events. These included memory impairment and confusion.

Long-term side effects and risks are not yet known.

[helvella in reply to Justiina]

And:

The study showed that one heart attack or stroke was prevented for every 74 patients taking the drug in the two-year trial.

Which means that of those 74 patients, between 51 and 59 suffered side effects (which could be anything from one mild effect to multiple unpleasant, potentially serious effects). Who can say it is right for those 51 or 59 to suffer for the sake of the one who does not then have a heart attack or stroke? It isn't that those 51 or 59 gain any benefit - they were the ones who would not have suffered the heart attack or stroke if they taken nothing! (Obviously, this is only looking at the two-year trial window. Over longer periods, they might have some benefit - or might not.)

(51 or 59 on the basis of 69% or 81% of 74 patients. Not exactly strict, analytical statistical appraoch, more finger in the air.)

[SmallBlueThing]

Investors unconvinced: reuters.com/article/us-hear...

Tempted by the offer of a refund if you suffer a heart attack or stroke?

[helvella in reply to SmallBlueThing]

At $7,700 per patient per year, even Mercury Pharma's Liothyronine doesn't seem quite so hideously expensive! And that might help in all sorts of ways in those patients for whom it is appropriate (but currently probably not even thought about).

Note: "Just like in statin trials the benefit appeared to grow over time,...". As I see it, the corollary could well be, "Just like in statin trials the negative effects appeared to grow over time," - except that the negatives of statins seemed to grow post-testing.

[bluebug in reply to helvella]

You mean "When we manipulate the data we can show increased benefits over time..."

[bluebug]

Nice to know we are all as sad as each other.

[leoopard]

This is utter rubbish. There is no such things as 'bad cholesterol' it is actually vital for building cells walls, for creating steroid hormones and a whole range of other issues. A family friend became severely ill due to inadequate cholesterol.

Next statins inhibit the productoin of other fats including co-enzyme Q10. The severe pain some people feel on them is likely due to this issue.

The next issue would be that the blood tests for LDL cholesterol are unable to disintinguish between small particle LDL (the stuff that furs your arteries up) and large particle LDL cholesterol (the stuff stimulated by releasing hormones including ACTH, TSH etc). Large particle LDL cholesterol play no role in Arteriosclerosis.

The USA has revoked its practice of giving men over a certain age Statins without good cause because some quite severe side effects began to occur. And guess what? The NHS adoped the same stupid policy wihtin weeks of the USA stopping this negligent practice.