by Seth J. Baum, MD, FACC, FACPM, FAHA, FNLA

Every generation or so, each medical discipline hopes to experience a revolution of monumental proportions. Statins, released in the 1980s, were the last cholesterol modifying medications that dramatically altered our ability to decrease heart attacks and strokes. Now we have the PCSK9 inhibitors. With them we have entered the “new age” in lipid therapy and I genuinely consider myself privileged to be a part. One drug was just approved; the other is just around the bend. These medications can decrease LDL cholesterol by 50% or more in patients already on statin therapy.

The significance of such profound LDL diminutions is this: We now know that LDL causes atherogenesis; thus, lower LDL should mean fewer heart attacks and strokes. Of course this fact must still be proved with any new class of medications, but there is every reason to believe it will be validated, and no reason to think it will not. Such trials are already ongoing. From a safety standpoint, PCSK9 inhibitors are human monoclonal antibodies and already studies of thousands of patients have revealed only minimal adverse events such as minor injection site reactions. Muscle pain is not an issue, nor is the genesis of diabetes; both represent problems we constantly battle with high dose statins. The current indications for these medications are either Familial Hypercholesterolemia (FH) or Clinical Coronary Heart Disease with inadequately treated LDL. There is far more to say about these medicines and I promise to do so. For now though I must continue to prepare for the 30th Anniversary of the American Society for Preventive Cardiology (ASPC) as our Annual meeting is just days away.  After that, we will do a deeper dive on the PCSK9 inhibitors. Promise.