Earlier this week saw the holding of the American College of Cardiology’s annual meeting in Chicago. Quite a lot of media interest in this scientific meeting centred on the drug currently going by the name of REGN727. It’s an injectable drug, and it lowers levels of supposedly unhealthy ‘LDL’ cholesterol. It does this, apparently, by inhibiting a protein called PCSK9, thus allowing more effective clearing of cholesterol from the bloodstream.
In a study presented at the meeting, REGN727 was administered to individuals in one of three doses. At the highest dosage, LDL levels dropped an average of 72 per cent. There’s been quite a bit of excitement in cardiological circles about this. Dr Rich Nishimura, a heart specialist who was head of the committee that chose which studies to highlight at the meeting is quoted as saying “This is a ‘wow’ study. It takes us to a whole new level of cholesterol control and could be a game changer in the future.” I’m unmoved, however.
I couldn’t care less about the impact that REGN727 has on LDL cholesterol levels. What I care about is the impact it has on health. Many doctors, especially cardiologists in my experience, view these as pretty much one and same thing. They are not.
By way of example, let’s look at the drug ezetimibe. This drug inhibits cholesterol absorption from the gut, and is an effective cholesterol lowerer. It’s licensed and prescribed on this basis. Only problem is, not one single study has shown it to improve health outcomes. Not one. In fact, there’s some evidence that it might actually worsen health outcomes.
Even if cholesterol reduction, per se, is beneficial (I doubt that it is), we need to remember that all drugs have the potential for side effects and hazard. Arsenic and cyanide might be fantastic for reducing cholesterol for all we know, but they still wouldn’t make very effective drugs.
Despite the fact that there is no evidence that ezetimibe improves health, there as been surprisingly little dissent about it in the medical community. Many cardiologists continue to write prescriptions for it in an effort to improve their patients’ ‘numbers’. The whole supposed point of this exercise, to improve the health of their patients, is often utterly lost.
This is, I think, how the drug companies like it. Having doctors believe that cholesterol reduction must somehow translate into better health down the line is one of the big deceptions of modern medicine.
Before we get all excited about REGN727 or any other cholesterol-reducing drug, we should really know its impact on health. How effective, if at all, is it at preventing heart attacks, strokes and deaths? What are its side effects and hazards, particularly in the long term.
I’m not one for predictions, but I won’t be at all surprised if it turns out that REGN727’s cholesterol-reducing power does not translate into much in the way of health benefit. And I won’t be too surprised either if it turns out to have some nasty side-effects over time. After all, in the area of cholesterol management, we’ve seen it all before.