(Focus - India)
Hypercholesterolemia, one of the common lifestyle diseases of the current times. To throw more light on this condition, decodeMR brings to you a discussion with Dr. Yogendra Singh, a prominent Cardiologist from India, who shared his insights on PCSK9 inhibitors as treatment options for Hypercholesterolemia.
Dr. Yogendra Singh is Associate Director, serving at Max Hospital, Dehradun.
Lifestyle modifications are helpful in managing hypercholesterolemia in a certain number of patients. It basically depends on the risk factor of that particular patient, if it is primary prevention or secondary prevention, and also what are your targets for LDL cholesterol.
Thank You, doctor, for joining us today.
Let’s start with your comment on how common is familial hypercholesterolemia (FH) in India?
Dr. Yogendra: Familial hypercholesterolemia is not very common in India.
So, doctor if it is present, how can it be diagnosed early and managed at the initial stage?
Dr. Yogendra: It can be diagnosed by doing lipid profiling, where a very high cholesterol level, especially LDL and total cholesterol level can indicate familial hypercholesterolemia.
Excluding familial hypercholesterolemia, high cholesterol levels are primarily due to unhealthy lifestyle choices. So, can lifestyle modification alone help in managing hyperlipidemia?
Dr. Yogendra: Definitely, lifestyle modifications are helpful in managing hypercholesterolemia in a certain number of patients. It basically depends on the risk factor of that particular patient, if it is primary prevention or secondary prevention, and also what are your targets for LDL cholesterol.
Doctor, is there any natural way in which hyperlipidemic patients can reduce their high cholesterol levels?
Dr. Yogendra: Yeah, definitely, why not. The reduction in consumption of fatty foods and exercising on a daily basis can reduce LDL cholesterol.
Doctor, there are several studies that show the negative impact of discontinuing statin, especially in older patients. So, once they have started on cholesterol medication, is it necessary to continue it for a lifetime?
Dr. Yogendra: Yes.
So, can't they stop this cholesterol medication doctor, even if their cholesterol level is low?
Dr. Yogendra: Usually, if there is an existing cardiac problem, then the target will be approx. 70 mg/dL or less than 100 mg/dL. So, if the cholesterol levels are very low then you can reduce the dose, but a cardiac patient has to take these drugs lifelong, irrespective of their cholesterol levels.
I don't see any head-to-head comparison between PCSK9 inhibitors and statins. Most of the studies have shown an add-on with PCSK9 inhibitors where we are not able to achieve the target with a statin.
Doctor, it was reported that those without a history of heart problems had elevated troponin levels when infected by COVID-19. So, could you please comment on the correlation, if there is any, between COVID-19 infection and heart damage?
Dr. Yogendra: COVID-19 affects the heart in different ways because it is a viral infection. So, it can cause myocarditis, or it can promote clot formation thereby leading to the acute coronary syndrome. In both situations, you can have a high troponin level.
Do you suggest any additional steps for hyperlipidemia patients affected by Covid-19 infection?
Dr. Yogendra: Hyperlipidemia patients usually have a long-term goal and for COVID patients all these issues are usually for the short-term. As because any effect on cholesterol, whether it is by medicine or diet, takes a few months to get the effective result and the actual benefit might start one year later. So, I do not see any connection between them.
What are your thoughts on PCSK9 inhibitors as treatment options for Hyperlipidemia?
Dr. Yogendra: PCSK9 inhibitors are basically utilized in patients in whom we are not able to achieve the target levels even with statins. For those patients, we can use PCSK9 inhibitors.
So, doctor, what are the advantages of using PCSK9 inhibitors compared to statin or the other hyperlipidemia drugs?
Dr. Yogendra: I don't see any head-to-head comparison between PCSK9 inhibitors and statins. Most of the studies have shown an add-on with PCSK9 inhibitors where we are not able to achieve the target with a statin. It's not statin versus PCSK9 inhibitors, it is probably statin with PCSK9 inhibitors.
Is there any challenge while using PCSK9 inhibitors?
Dr. Yogendra: I think the cost is an issue right now with PCSK9 inhibitors.
Doctor before we conclude this discussion, what will be your key takeaway message for a hyperlipidemia patient reading this article?
Dr. Yogendra: My message for the hyperlipidemia patient is to change his lifestyle and diet first so that he can control his lipid level and if the lipid level is still high then he can use a statin for the rest of his life.
Thank you so much doctor for providing your insights on hyperlipidemia.