A 3-STEP GUIDE TO KEEP THAT ARTERY-CLOGGING CHOLESTEROL IN CHECK.
A new injection, along with dietary changes and regular exercise, can help cut your heart risk.
High cholesterol is a silent killer around the world. And Indians are even more susceptible, owing to genetics, poor diet, and lack of physical activity. According to the Indian Heart Association (IHA), South Asians have lower good cholesterol (HDL) levels, which is three times more common in patients with premature heart disease. And with every 40-point increase in total cholesterol, the chances of young people dying from heart disease doubles.
So, getting your cholesterol tested — and under control — is crucial. The Cardiological Society of India has called for non-fasting measurements, recommending that you get your first test at 18. So, if you’re old enough to vote, you’re old enough to get yourself tested. But testing is just the first step. What do you do when the results are not optimal?
LIFESTYLE CHANGE IS KEY:-
Lipid-lowering medications can help control cholesterol levels, but making diet and lifestyle changes are more important to reduce heart disease and stroke risk. “Lifestyle changes such as regular aerobic exercise, quitting smoking, adopting a low-fat diet, and maintaining a healthy weight are crucial.”
The IHA recommends 30 minutes of exercise, five days a week. Losing just 10% of your body weight will help lower your cholesterol and triglyceride levels.
Diet plays a crucial role in regulating cholesterol levels. Consuming foods rich in saturated and trans fats can elevate LDL cholesterol. While reducing intake of red meat, full-fat dairy products, processed foods, and fried foods helps keep cholesterol under control, incorporating foods rich in fiber, such as oats, beans, fruits, and vegetables, can help lower LDL cholesterol. Replacing ‘bad fats’ with ‘good fats’ is good for your heart. An easy way to do this is to choose heart-healthy vegetable oils to cook food.
Quitting smoking is one of the favors you can do to your heart. Smoking not only lowers your HDL, it also makes the HDL you do have worse at its protective job. Quitting smoking can increase your HDL in a matter of weeks.
HOW STATINS HELP:-
While diet and exercise are effective, there may be instances where medical intervention is necessary. Individuals with very high LDL cholesterol levels, especially those over 30, may require medication. Moreover, people with additional risk factors, such as smoking, hypertension, diabetes, or a family history of heart disease may need treatment even with moderate cholesterol levels. Doctors usually prescribe statins to those with perennially at-risk levels of LDL or those who have had a heart attack or stroke. Statins work by stopping the liver from producing more cholesterol than required. Doctors say statins arrest inflammation in the blood vessels and prevent heart attacks and strokes in people with normal cholesterol.
A recent study published in the journal Heart has recommended statin treatment for most people aged over 70, saying it would improve health among senior citizens. “Many people around the world are suffering from preventable heart disease and stroke due to insufficient access to effective low-cost treatments such as statins.” Of course, statin use would have be to be complemented by diet and exercise, and healthy lifestyle choices.
NEW TWICE-A-YEAR JAB:-
A third line of treatment for patients who are unable to tolerate statins is Inclisiran, a new bi-annual injectable treatment for reducing LDL which was launched in India in January this year.
Inclisiran is a gene-silencing drug that targets and ‘switches off’ the PCSK9 gene protein in the liver. This allows the liver to remove more harmful cholesterol from the bloodstream. Statins are daily medications but Inclisiran only needs to be injected every six months. This therapy was approved in the US and the UK two years ago. Inclisiran can reduce cholesterol by up to 50%.
“The patients had persistently high cholesterol levels despite being on statins and, in some cases, had already undergone angioplasty. However, their LDL levels remained high, leading to plaque build up in other arteries that could cause heart attacks. Inclisiran significantly lowered LDL levels. It’s a valuable option for patients who have not responded to traditional therapies.” The drug works particularly well in combination with statins for patients with crucial and modern blockages. The drug effectively manages cases of homozygous familial hypercholesterolemia (HoFH) – a rare genetic disorder where individuals inherit two mutated genes, leading to dangerously high cholesterol levels. “In HoFH, the body’s inability to effectively remove LDL cholesterol significantly increases the risk of early cardiovascular disease.” But one must have a clean and healthy lifestyle for such drugs to be most effective.
It’s a better bet than statins. “Statins sometimes have bothersome side effects like myalgia, liver problems, especially when used long-term. But Inclisiran has proven to be safe and extremely tolerable in clinical trials.” Besides, statins need to be given daily, which makes it difficult for India’s elderly, who often have poor social support and live in rural areas where the drug is not readily available. “Inclisiran will get around these compliance issues as this drug can be given under the skin once in three months for the first two doses, followed by twice yearly.”
It does have a few side effects, but the bigger hurdle is the cost of the drug. Each injection costs between Rs 95,000 and Rs 1.25 lakh in India; in the US, it’s over Rs 5 lakh. But the fact that its just one injection every six months will lead to wider adoption in the future. “The major hurdle right now is the cost, but as prices decrease, I expect the therapy to gain more acceptance.”
