Cholesterol is a totally necessary lipid for living things, including humans. It is a fundamental component of the membrane of all our cells. However, once it reaches excessive levels, this cholesterol ends up depositing itself in the walls of the blood vessels, in which they form the atheroma plaques that can obstruct the veins and arteries. That is, it triggers the development of atherosclerosis and, therefore, increases the risk of cardiovascular disease and death. So what can you do to lower your cholesterol levels? Basically, adopt a healthy lifestyle. And in those cases where the measure is insufficient, combine it with pharmacological therapy. And in this context, what is the most effective treatment? According to the GLAGOV study, an international study led by researchers from the Department of Cardiovascular Medicine at the Cleveland Clinic, the combination of statins with a new drug called ‘evolocumab‘.
The scientific evidence that shows the GLAGOV study gives a reason to trust more in evolocumab, a drug that is quickly becoming an invaluable therapeutic tool for patients with a high cardiovascular risk or for those who have already had a cardiovascular event.
Statins are a group of drugs that are used to lower cholesterol levels in the body. Statins that are currently among the most prescribed drugs worldwide, to the point that it is estimated that one in four american over the age of 45 are taken to lower their cholesterol. However, although it is very effective, treatment with these drugs has a ‘limited scope’, which may be insufficient for patients who already have a very high cardiovascular risk. “Normal” cholesterol was any level below 300 mg/dL. But over the course of four decades we have accumulated more and more evidence that lowering these levels is always associated with a benefit. So how to lower cholesterol even more?
According to the GLAGOV study, statins must be combined with evolocumab, a protein-converting enzyme subtilisin/kexine type 9 (PCSK9) inhibitor already approved for use in the USA.
Specifically, the study was carried out with the participation of 968 patients with ischemic heart disease who were administered, according to a totally random criterion, the combination of statins and evolocumab or statins plus placebo – control group – for 76 weeks.
The authors used the intravascular ultrasound (IVUS) technique to evaluate changes in the percent volume of atheroma – or PAV, which measures what proportion of the blood vessel lumen is occupied by the atherosclerotic plaque – and in the total volume of the atheroma – VAT, with which the volume of the plate is measured. And according to the results, combined treatment with evolocumab not only induced the largest drop in ‘bad cholesterol’ levels observed to date in any study – up to an average level of 36.6 mg/dL, by 93.0 Mg/dL in the control group, but also reduced the PAV by 0.95% – whereas in the placebo group it grew by 0.05% – and in a greater number of patients – 64.3%, by a 47, 3% of the control group, and decreased the VAT to a greater extent -5.8 mm3 by 0.9 mm3 with placebo – and in more participants – 61.5% by 48.9%.
In short, the addition of statin therapy is associated with the greater reduction of ‘bad cholesterol’ seen so far and reduces atherosclerosis. In fact, as the results show, up to two-thirds of the participants experienced a regression of the atherosclerotic plaques in their coronary arteries.
As Stephen J. Nicholls, research director, concludes, “In the light of previous studies, we did not know whether our study would show an additional regression of plaque with LDL-C levels below 60 mg/dL. Thus, one of the major findings of our study is the continued reduction of atherosclerotic plaque with LDL-C levels that are well below the commonly accepted thresholds”.