Dr Warwick Jaffe on current lipid management

Author: Dr Warwick Jaffe

Transcript:

Dr Patricia Ding:

Right. Good morning. My name is Patricia Ding. I'm one of the cardiologists at Ascot Cardiology. I'm here with Dr. Warwick Jaffe, International cardiologist from Ascot Cardiology. Morning, Warwick.

Dr Warwick Jaffe:

Morning, Patricia.

Dr Patricia Ding:

So, and tell us about the current state of play for lipid management.

Dr Warwick Jaffe:

In most patients, a statin is given, and if the patient doesn't achieve their target, you'll add Ezetimibe.

Dr Patricia Ding:

Right. So what is the target of a load density lipoprotein, that we should aim for, at the moment?

Dr Warwick Jaffe:

I'd describe it as a moving one. Few years ago, it was two. Then it got reduced to 1.7. The latest European guidelines suggest that in high-risk patients, we should be aiming for an LDL of around 1.4, Patricia.

Dr Patricia Ding:

All right. And so, what about the people who can't take statins, or don't achieve the target?

Dr Warwick Jaffe:

That's a big problem and there's a lot of these people around. And most of them at present, go untreated. Overseas, the PCSK9 inhibitors have been used a lot.

Dr Patricia Ding:

And how does PCSK9 inhibitor work? And how is it given?

Dr Warwick Jaffe:

PCSK9 is a substance that destroys the LDL receptor. So, the more LDL receptors you've got, the lower your cholesterol is. So, to destroy these receptors, we can produce an antibody. It's like a monoclonal antibody. It has to be injected, quite frequently. And it's very expensive. So PCSK9 inhibitors have not really been used, very much at all. In New Zealand, we have Praluent, which is about $9,000 a year. So, of course that's not used in very many patients.

Dr Patricia Ding:

What about the other new options?

Dr Warwick Jaffe:

A new option is the short interfering messenger RNA drugs. And these are oligonucleotides. They're much cheaper to produce and how they work is quite a different way, is they interfere with the messenger RNA, which is the messenger that produces the PCSK9, in the cell. So what that means is, the PCSK9 isn't produced at all.

Dr Patricia Ding:

So, where is this medication at, since it's cheaper than a PCSK9 inhibitor?

Dr Warwick Jaffe:

Inclisiran is the first of these drugs. It is in phase three trials, which we expect to be completed by the early part of next year. And as soon as the middle of next year, this drug could be available. Of course, the key thing about it, is what's the price going to be? The Medicines Company, which produces this drug, has just been bought by a large pharmaceutical company for $9.7 billion. So that's the 1,001 question is how much this is going to cost, and whether it's going to be available to your patients.

Dr Patricia Ding:

Right. So just to recap. The target LDL at the moment, is 1.4 or less. And new medications available coming to us, potentially could be a PCSK9 inhibitor, plus short interfering messenger RNA, potentially be available in the near future, as well. Right. Thank you very much Warwick, for your time today.

Dr Warwick Jaffe:

It's been a pleasure. Thanks, Patricia.

Dr Patricia Ding:

Right. Yeah. So, if you're interested, there'll be a link down below for you to read some more information about these medications and guidelines. Thank you very much.

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