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By Leon Thompson

Photo: Fatty acids in the blood of a person with high cholesterol and high triglycerides.

June 11, 2016 (East County) – High cholesterol plagues millions of Americans.  Too much of the wrong cholesterol can predispose a narrowing and hardening of arteries leading to stroke or coronary artery disease (CAD).  CAD is the number one killer of men in America and the second most deadly disease among women, second only to breast cancer.

For most people dietary and life-style changes are enough to control cholesterol.  A healthy diet with a good mix of fresh vegetables and fruit, aerobic exercise and a calm heart is the key to a happy life and a healthy cardiovascular system.

However, every now and then, we hear about a long distance runner who drops dead in the middle of a marathon!  Sometime the first symptom of CAD is sudden death.  This is not good news for anyone who eats well, exercises, doesn’t smoke and lives a normal life.   For many people high cholesterol is genetic or familial as it’s called, caused by specific genetic abnormalities.  Also, hyperlipidemia may be idiopathic; that is, without known cause.

Obviously, many people need additional help controlling their cholesterol.  Along came statin drugs, the most widely prescribed drugs in America.  Statins reliably reduce cholesterol by a measurable percentage large enough to make a difference.  But statin drugs are not tolerated well by all people. As a result, in clinical terms, afflicted individuals lack the ability to produce lipoprotein lipase enzymes necessary for effective breakdown of fatty acids.  The result is muscle cramps, stiffness, and spasm associated with myopathy, a painful muscle disease. 

Recently approved by the FDA is evolocumab, a non-statin monoclonal antibody designed for the treatment of hyperlipidemia.  Evolocumab is a fully human monoclonal antibody that inhibits LDL receptors in the liver.  In human language, that means a protein was found that lowers the bad cholesterol.  The drug is by physician’s prescription, expensive and available by injection only. 

Monoclonal antibodies are specific antibodies that are made by identical immune cells that are all clones of a unique parent cell.  Monoclonal antibodies bind to the same substance.  They can then serve to detect or purify that substance.

Lipid-lowering agents such as fibrates and omega-3-fatty acids can be used to lower tri-triglyceride levels; however those drugs are very often not effective enough to reach treatment goals.  Additional measures are avoidance of agents known to increase endogenous triglyceride levels, such as alcohol, estrogens, diuretics, isotretinoin, and antidepressants.

Released by the FDA and its counterparts in Canada, evolocumab has many cardiologists hopeful there is a new weapon in the battle against coronary heart disease.

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