VIDEO: Deepak Bhatt discusses the role of new cholesterol-lowering agents

Deepak Bhatt, MD, MPH, executive director of the interventional cardiovascular programs at Brigham and Women’s Hospital and professor of medicine at Harvard Medical School, explained the new generation of cholesterol-lowering drugs and their roles in various types of patients. 

"In terms of cholesterol lowering in general, it is a really exciting time," Bhatt said. "There are now a lot of different options right now." 

For starters, he said any patients at risk of cardiovascular disease should be on statins. For higher-risk patients, ideally they should be on a high-dose statin if they can tolerate it. That is the backbone for cholesterol-lowering drugs, Bhatt said.

He said the generic agent ezetimibe is also a good option and less expensive than the name-brand statins on the market. He said it has low side effects and good clinical evidence. 

More recently, PCSK9 inhibitors were introduced to the market, Evolocumab (Repatha) and alirocumab (Praluent). He said the side effects are low, and efficacy is high.

"They gave great cardiovascular outcomes trial data, with significant reductions in cardiovascular events," Bhatt said. 

However, he said these drugs came to market with a very high price point, which has prevented from from seeing wide-spread use. 

"The drugs came out at a very high price point, which was something physicians, patients and third-party payers were not going to tolerate. So that has been a limiting factor," Bhatt said. 

However, prices have started to come down, so for the right patients, this high cost drug might be a good option for the right patients with very high LDL who are also high risk. 

Bempedoic acid (Nexleto) is another newer agent that has ongoing clinical trials. If they are positive, Bhatt said it will be a great option for statin intolerant patients.

"You can quibble and say a patient does not meet the strict definition of statin intolerance, but as a pragmatist, if a patient is not taking their statins for whatever reason, if they feel they are having a side effect, there may be a potentially large role for bempedoic acid," Bhatt explained.

Inclisiran (Leqvio) is another LDL lipid-lowering drug that may have a significant impact, Bhatt said.

"I think this approach is going to be extremely valuable," he explained. "We already known inclisiran lowers LDL cholesterol by a lot, but beyond that, it can be administered every six months. And I think that is potentially a great advantage for patient adherence. I can force a future where patients are coming in to see their cardiologist or primary care physician every six months and getting a shot, so you would have 100% adherence."