Currently viewing the category: "bad cholesterol"

Blockbuster Drug Cements Dominance

By On · Add Comment · In AMG 145, bad cholesterol, LDL, LDL receptor, negative regulator, Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9), U.S. Food and Drug Administration
$ Cha-ching $

Read carefully:

“Monthly injections of an experimental drug from Amgen Inc slashed levels of cholesterol by up to an additional 66 percent in patients already taking statins, researchers said on Sunday, making it a potential strong rival to a similar drug being developed by Regeneron Pharmaceuticals Inc.”

That’s right, millions of you reading this will be taking this drug in the very near future. Or maybe it’s 2022, and you’ve been taking the drug for the last few years. Either way, AMG 145 will be the newest wave in the medical industry’s fight against cholesterol.

AMG 145 is a fully human monoclonal antibody to Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9), a negative regulator of the low-density lipoprotein receptor. A recent study shows AMG 145 reduces PCSK9 activity, a protein that reduces the liver’s ability to remove LDL or “bad” cholesterol from the blood. Less PCSK9 = more LDL removal by liver. AMG 145 is called a PCSK9 inhibitor.

The early phase 1 trial was conducted to test the safety of AMG 145. Researchers followed 51 patients who received a shot either once every two or four weeks. They found that some subjects, those already taking high dose statins (popular prescription cholesterol lowering drug), had an average of 63% reduction of their LDL levels. And those on a low dose statin regimen fared even better, with an average 66% reduction of LDLs.

Manufacturer Amgen is rather pleased with the results, and why not? A drug of this magnitude has the promise of dominating a market for ten plus years. I am certain that medical doctors, administrators, federal overseers and the mass medical marketing machine are also ecstatic, as this can darn-near guarantee a “good” decade for medical business interests. Industry analysts says PCSK9 inhibitors, if approved, could generate annual sales approaching $20 billion.

Although insiders caution that bigger trial are needed, they do hope a technicality can get AMG 145 through the U.S. Food and Drug Administration (FDA) hoops and approved for sale. A big question remaining is whether U.S. regulators would approve the drugs without first requiring major studies that evaluate long-term heart attack and stroke risk.

“That’s the subtle wrinkle here,” said Steven Nissen, head of cardiology at the Cleveland Clinic. He speculates that the FDA might be willing to approve them without such costly outcomes trials because statins were approved without them on the basis of their ability to lower cholesterol. Nice to know. 

Because both statins and the PCSK9 inhibitors, although different classes of medicines, exert their influence on the LDL receptor–a protein that carries LDL cholesterol through the bloodstream–Nissen thinks that it might be enough to construe a similarity argument, getting it passed through the FDA without necessitating additional testing. Just another day at the office for Big Pharma.

Well, I go back to my original point–be prepared for indoctrination into the newest era of bad cholesterol eradication. The PCSK9 inhibitors are here to stay. Watch them take the world by storm as the new medical blockbuster, all but cementing medicine’s dominance on the health care market. Coming to doctor’s office near you. Ten more years, ten more years…

Meet Ultra-Bad Cholesterol

By On · Add Comment · In bad cholesterol, diabetes, fast-food, good cholesterol, low density lipoprotein (LDL), metformin, MGmin-LDL, prediabetes, soda, sugar
You’ve heard of “good” cholesterol and “bad” cholesterol–now meet their wicked stepbrother, “ultra-bad” cholesterol…so bad, it forms stickier plaques, and makes its carrier even more susceptible to heart disease and stroke.  Who’s got this badass sticky-plaque cholesterol?  Diabetics.  But before you think that’s not you…let me add prediabetics to the mix as well.

British scientist have found the super-sticky cholesterol by essentially recreating in the lab.  By glycating low density lipoproteins (LDLs), that is, by adding sugar groups to the molecule, they turned the “bad” LDLs into “ultra-bad” MGmin-LDLs.  The added sugar groups change the cholesterol’s shape, making it stickier and more likely to attach to blood vessel walls.  Once cholesterol sticks to the arterial walls, the plaques narrow the lumen (space), reducing blood flow and thus increasing the probability of heart attack or stroke.  Diabetics and prediabetics are at risk due to the higher levels of sugar circulating through the blood.

Of course, the discovering scientists (University of Warwick in the UK) and the medical community is excited because the findings uncover how a common type 2 diabetes drug, metformin, fights heart disease by blocking the transformation of normal LDL into the super-sticky LDL.  Which of course means greater possibilities for new drugs.

But my interest is from a different angle.  It’s for me to stand on a soap box and say: Please people, listen, decrease your sugar intake or remove it from your diets altogether.  Processed sugar is one of the greatest health impediments of the modern world.  The number of illnesses and organ diseases attributable to excess sugar in the diet are astronomical.

While in doctor school, I read 1,500 pages of pathology text required for the curriculum, and it was my observation that excess sugar (along with tobacco and alcohol use) is one of the primary causes of disease in contemporary civilization.  And our foods are filled with it.  Sugar is in everything!  From cookies and cakes, to sauces, meats, breads, cereals, soups, stews, children’s food…and the list goes on and on.

Fast food is laden with sugar.  But be not afraid…here, wash it down with a soda.  Yes, the American drink of champions!  I know I’m a freakin’ bummer, but somebody has to say it.  Drop the sugary, frosted, high fructose corn syrup-laden CA-RAP before your arteries get filled with super-sticky MGmin-LDLs.  Dang!  Seventy-nine million people in the United States today have prediabetes.  Freakin’ duh!

Let me put it in perspective: You know how you think the guy or gal you see smoking a cigarette is going to have a heart attack one day?  Now you can do the same for the soda drinker.  Think about it.

A Case Against Statins

By On · Add Comment · In atherosclerosis, bad cholesterol, cardiovascular disease, essential fatty acids, good cholesterol, HDL, heart disease, LDL, magic bullets, statins
One of the first things doctors learn in rudimentary physiology class is that, when it comes to preventing heart disease, high HDL or “good” cholesterol is more important than low LDL or “bad” cholesterol. In fact, HDL levels are four times greater than LDL levels in their ability to predict the development of coronary atherosclerosis. Basic, basic, basic physiology.

But an interesting thing happens between doctor school and practicing–it’s called influence from the outside world. In the case of doctors, that influence often comes from pharmaceutical industry. C’mon Campos, not another evil pharmaceutical industry story (hey, I haven’t written one yet, please). No, no–it’s more like another example of how we’ve come to worship outside factors when it comes to our health. Check this one out.

Recent research published in the New England Journal of Medicine shows that no matter how much bad cholesterol is lowered in the blood, it’s the amount of good cholesterol that still reigns supreme. Yes, the concentration of your HDLs (high density lipoproteins) plays a vital part in preventing cardiovascular diseases, like heart attacks and strokes.

Yeah, so? Well if you haven’t heard yet, those hyper-pedastalized miracle drugs known as statins are some of the most prescribed drugs of our day. Statins work by lowering LDL (low density lipoproteins) levels in the blood, and this, it has been promised, will lower our risk of heart disease. Great! Prescribe them like crazy. People don’t work out. People don’t eat right. Who cares? Give ’em statins. You’ve got boderline high cholesterol. Statins. You’re almost diabetic? Statins. You’ve seen the cholesterol commercial and you’re concerned? Statins.

Statins. Statins. Statins.

Well I’ve got news for you. You want to lower your risk of cardiovasular disease? You’ve got to watch what you eat and work out, period. Oh yeah…it’ll help if you quit smoking too, but how about just starting with exercise? You see, I’ve got a real problem with the idea of looking for magic bullets. They are illusions, people–ILLUSIONS! They give false security and false hopes. Nothing in life is free. You’ve got to work for everything. Exercise. Diet. That’s the real answer. Not statins.

OK, I’ll be fair. For people who have dangerously high levels of LDLs–if I was their MD–I’d give them statins for a very brief period, and I’d absolutely prescribe heavy doses of lifestyle management (read: nutrition and exercise). But I wouldn’t perscribe statins for people with boderline normal cholesterol levels as some Dr. Idiots are recommending (also read this–effin’ scary).

According to Dr. Philip Barter of the Heart Research Institute in Sydney, one of the lead authors of the study, “Even when LDL is taken down to very low levels, the kind of levels people say should be the aggressive targets, having a low HDL is still associated with a substantial increase in risk. (emphasis mine)” So, basically, you’ve got to work to bring your HDL levels up to par. And here’s the beauty: It’s the ratio of total cholesterol to HDL that really matters (see this brilliant explanation here), where total cholesterol = HDL+LDL. Therefore, HDL+LDL/HDL. So, if you bring up your HDL levels, you don’t need statins. Duh.

OK, here’s how you can raise your HDL levels–exercise regularly, eat wholesome foods, take essential fatty acids, and moderate your smoking and drinking habits. And you can naturally decrease your LDL levels by decreasing saturated fat intake, maintaining good body composition, increasing dietary fiber, and increasing aerobic exercise. Booyah!

But wait…fugdat. Ain’t there a drug I can take, Homey?

Sure Pfizer is working on one. It’s called torcetrapib. Oh wait. It killed people in a large drug trial. Oh well–I guess you’ve gotta work out. Says Barter again: The alternative is to “become lean and become very active. That’s probably as effective as anything we have at the moment. But most people who try don’t succeed,” Barter said. “The biggest frustration is that we don’t have the magic bullet like we do for the LDL.”

Ah yes, the ‘ol magic bullet. Well, keep looking–it’s your time, your money, and your health. If you want to believe, then be my guest. But I’ll just be over here dancing with the Tooth Fairy.

Copyright © 2013 Dr. Nick Campos - All Rights Reserved.