For over 20 years, statins (such as atorvastatin and simvastatin) have been one of our primary weapons to fight heart and vascular disease, because of their ability to reduce cholesterol, and subsequently prevent heart attacks and strokes. But in many patients, statins are poorly tolerated or ineffective at reducing cholesterol to the desired target.
Recently, a new class of cholesterol-fighting drugs were discovered, and the first of these agents has been approved by the FDA. These medications, called PCS-K9 inhibitors, work differently than statins, and do not seem to have the common side effects of statins, such as muscle soreness. They appear to markedly lower cholesterol, and appear to be safe. This article in the Wall Street Journal nicely summarizes the promise of these drugs, as well as the drawbacks (the drugs are very expensive, and must be given by injection).
In addition to those drawbacks, the new agents have yet to establish a long-term track record of safety and prevention of heart attacks and strokes. So initially, these agents will be reserved for patients who have genetic elevations of cholesterol, and those with known cardiovascular disease for whom statins are ineffective or not tolerated. In the near future, more agents will become available (lowering their price), and further studies will guide how to best use them.
In the meantime, statins remain our best weapon against high cholesterol – and are safe and well tolerated, even when given for many years. And as the above article documents, well-done studies have shown that most muscle soreness in patients on statins is either unrelated to the medication, or resolves when a different statin is used.
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