Welcome to Doctor Warrick's Podcast Channel. Warrick is a practicing cardiologist and author with a passion for improving care by helping patients understand their heart health through education. Warrick believes educated patients get the best health care. Discover and understand the latest approaches and technology in heart care and how this might apply to you or someone you love.
In this podcast, Doctor Warrick Bishop discusses the latest approaches and technology in heart care, specifically focusing on cholesterol therapy in 2022.
He explains that lowering cholesterol reduces future risk for individuals with high-risk plaque, such as those who have had a stroke or heart attack. However, there is debate about whether cholesterol should be lowered in otherwise healthy individuals without any idea of their propensity to put plaque in their arteries. Statin side effects, particularly muscle aches and pains, are reported in between 5% to 15% of patients, which can make it difficult to meet cholesterol-lowering targets.
Ezetimibe is an underutilized drug in Australia that can bind cholesterol in the abdomen and alter absorption, providing a better cholesterol-lowering effect when combined with a low dose of statin. PCSK9 is a protein that can be inhibited by proteins, antibodies, and other things, and can be injected into individuals to get their cholesterol down. There are also medications close to clinical utilization that can stop or interfere with the production of PCSK9 within the liver cell. Other agents on the horizon include Bemperdoic Acid, C-TEP inhibitors, and angiopoietin-like-3 inhibition.
Finally, there is talk of RNA modulation or gene editing, which could last a lifetime and deliver over 200 days of cholesterol lowering.
- Lowering cholesterol reduces future risk for individuals with high-risk plaque, such as those who have had a stroke or heart attack.
- Statin side effects, particularly muscle aches and pains, are reported in between 5% to 15% of patients and tend to be dose-related.
- Ezetimibe is an agent that binds cholesterol in the abdomen and alters absorption, and is generally very well tolerated and works extremely well with statins.
- PCSK9 is a protein that sits next to the LDL receptor and can be inhibited by proteins, antibodies, and other things to get cholesterol down.
- PCSK9 inhibition can be achieved through a monoclonal antibody injection, which offers up to a 60% reduction in LDL levels.
- mRNA interference is a technology that can stop or interfere with the production of PCSK9 within the liver cell, and the agent Inquisirine is close to completing clinical outcome trials.
- Injection of Inquisirine will give almost six months of reduced LDL cholesterol levels.
- Bemperdoic Acid is an agent that works through the ATP citrate lyase pathway and has an enzyme action that is unique to the liver only and doesn't cross over with muscles.
- C-TEP inhibitors are a group of drugs that work to lower LDL cholesterol and raise HDL cholesterol, and Obicetrapid seems to hold promise.
- RNA modulation or gene editing could last a lifetime and deliver over 200 days of cholesterol lowering.
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