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Heart disease remains the world’s biggest killer, but a new drug could soon be widely available which could prevent heart attacks and strokes in substantial numbers.

The drug – “evolocumab” – targets ‘bad’ cholesterol by changing the way the liver works. This type of cholesterol causes blood vessels to ‘fur up’ and become easily blocked, starving the heart or brain of oxygen carried in the blood and leading to heart attacks or strokes.

Worldwide, around 15 million people die each year from heart attacks or strokes, but international trials of the new drug on 27,000 patients showed it could cut this type of cholesterol to unprecedented levels. Millions of people already take drugs called “statins” to reduce the amount of bad cholesterol, but the trials suggest evolocumab will be a far more successful treatment.

“It is much more effective than statins at reducing bad cholesterol,” said Professor Peter Sever, who organised the UK phase of the international trials of evolocumab. “The end result was cholesterol levels came down and down and down and we have seen cholesterol levels lower than we have ever seen them before in the practice of medicine.”

Patients in the trial were already taking statins to reduce their cholesterol, but the new drug brought their levels down significantly further.

Prof. Sever, from Imperial College, London, added: “The patients (in the trial) would have another 20% reduction in risk and that is a big effect. It is probably the most important trial result of a cholesterol-lowering drug in 20 years.”

The results of the two-year trials have already been published in the USA and reported at a meeting of the American College of Cardiology. Here in the UK, the National Institute for Health and Care Excellence (NICE) has already published a recommendation supporting the use of evolocumab for several types of patients with persistently high cholesterol and considered at high risk of heart attack or stroke.

Dr Derek Connolly, Consultant Interventional Cardiologist at Birmingham City Hospital, said: “By lowering cholesterol in such patients there is real potential to avoid death and disability from heart attacks and strokes – events which are very costly in both personal and financial terms. So this news from NICE is excellent for patients and excellent for the NHS.”

Evolocumab is an ‘antibody’ which mimics the way that the body’s immune system fights infection, but it has been designed to target a specific protein in the liver. This makes the liver better at segregating bad cholesterol out of the blood and breaking it down. Clinical trials suggest such antibody drugs could reduce bad cholesterol levels by up to 60% and several pharmaceutical companies are now exploring this approach.

The new drug is given by injection into the skin every two to four weeks and would be most likely used alongside statins rather than replacing them. As with any treatment, cost is a factor, but it is likely that the cost would come down as production of the drug increases and more competing drug companies enter the market.

National charity the British Heart Foundation has given a cautious welcome to news of the drug’s success in clinical trials. It said the results represented a significant advance in tacking the world’s biggest killer, but added that it was too early to be certain of the drug’s long-term benefit.

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