Studies by Imperial College London and University College London have revealed methods of reducing harmful LDL cholesterol by over 60% within early cases.
Recent findings by Imperial College London have proved a reduction of low-density lipoprotein (LDL) – commonly referred to as bad cholesterol – levels early on could be far more effective than later-stage treatment.
A decrease of just a tenth from the British Heart Foundation’s recommendation of 3 mmol/L is enough to cut long-term risk of serious cardiac events by a quarter. A necessary LDL reduction almost eight times higher is required in groups treated at a later stage. They need larger doses of cholesterol lowering drugs such as statins which then increases the risk of intolerance.
Due to factors such as lifestyle and an aging population, the number of people in the UK with heart disease is expected to rise from eight million to ten million over the next 15 years. Under current practices, cholesterol levels are a key indicator of an individual’s ten-year risk of heart attack or stroke, with statins more often being prescribed for those determined high risk.
A report from the American Journal of Preventative Cardiology shows that a much earlier intervention of just small reductions in LDL cholesterol, needing far smaller quantities of drugs, can significantly reduce the risk of cardiac events
“Current practice relies on ten-year risk,” said Irene Karungi, research assistant at the Imperial School of Public Health. “Our analysis shows the benefit of reducing LDL in people who are low risk is much greater than waiting until they might become high risk,” she added.
Analyses have shown that across 17 clinical trials, the lower the patient’s risk, the smaller the reduction of LDL needed to be, and thus the smaller the effective dose of statins would need to be to achieve the same effect.
One-off gene therapy
An alternative to the drug-based approach to bad cholesterol has been outlined by a study involving scientists from University College London.
The research has revealed the potential for one-off gene therapy to treat high LDL levels, as opposed to the traditional daily-pills or regular injection approach currently being used by more than seven million people in the UK.
This provides a solution to the problem of people not taking their cholesterol medication, as up to half of those taking cholesterol medication stop within a year for a variety of reasons such as side effects, or non-adherence.
The new VERVE-102 gene therapy, delivered as a single-dose infusion, decreases the production of the PCKS9 gene, which prevents the body from clearing LDL from the blood. Of the 35 adults with an inherited form of very high cholesterol or coronary artery disease diagnosed at a younger age than normal, high doses of the therapy resulted in a reduction of LDL cholesterol levels by up to 60%, with an 18-month follow-up showing lasting results with little to no side effects.
“These findings show the technology works, is safe and helps lower cholesterol to levels similar to medicines we currently have”, said Riyaz Patel of the UCL Institute of Health Informatics, further describing the breakthrough as “transformative in preventing heart attacks and strokes over the long term”.
Overall, these findings point towards a clear direction; the future of preventing cardiac events may lie in early action. New solutions include traditional ones such as statins simply being offered to those at lower risks, to the potential for gene editing tools which could give a one-off treatment to target the direct cause of high LDL. Shifting from late-stage crisis management to early prevention could transform the way we tackle high cholesterol, offering the possibility for millions to avoid the disease before it takes hold.
