A landmark study has shown an innovative new drug will prevent heart attacks and strokes in Scotland by cutting bad cholesterol to unprecedented low levels.
The large international trial on 27,000 patients with 74 trial sites in the UK included the Royal Infirmary of Edinburgh and Ninewells Hospital in Dundee.
The new drug evolocumab was approved for use by the Scottish Medicines Consortium last month and was found to reduce the risk of a heart attack by 27% and the risk of a stroke by 21% versus therapy with statins.
The patients in the trial were already taking statins and yet their risk was cut further by the new medicine.
Prof Peter Sever, of Imperial College London, a member of the study’s Executive Committee, said this “is probably the most important trial result of a cholesterol lowering drug in over 20 years”.
An estimated 670,000 people live with cardiovascular disease (CVD) in Scotland. The highest CVD death rates in the UK are in Scotland with early death rates from CVD (before the age of 75) also the highest. Over 4,600 people under the age of 75 in Scotland die from CVD each year.
Professor Naveed Sattar, of the Institute of Cardiovascular & Medical Sciences, University of Glasgow, said: "The results of this trial confirm what was hoped.
“Namely we have a new, safe way to lower cholesterol and heart attack risks that works on top of statins.
“However, the results need to looked at carefully to work out which patients should be targeted.
“The drugs current high costs mean that only those at very high risk of heart disease and with persistent high cholesterol despite statins and other agents will be eligible.
“To what extent these new results help expand the population eligible for these drugs needs careful analyses of costs versus benefits and each health authority will need to do their calculations."
Evolocumab changes the way the liver works to also cut bad cholesterol. The price varies but it is thought to cost the NHS around £2,000 per year when given to patients who do not respond to statins.
Dr Isla MacKenzie, Clinical Reader and Honorary Consultant Physician, University of Dundee and Ninewells Hospital, said: “It’s an exciting advance in that we’ve found another treatment that lowers the risk of heart attacks and strokes in patients who are already at high risk and Scotland has one of the highest incidences of acute heart disease.
“This is significant but the mainstay of therapy will still remain with statins and this drug may be used in selected patients who are particularly high risk – more likely to be people who have already had cardiovascular events like heart attacks or strokes and also still have high cholesterol despite other treatment.
“Cost is an issue as it's significantly more expensive than other drugs like statins for example.”
Bad cholesterol is the villain in heart world - it leads to blood vessels furring up, becoming easy to block which fatally starves the heart or brain of oxygen. It is why millions of people take drugs called statins to reduce the amount of bad cholesterol.
Evolocumab is an antibody just like the weapons used by the immune system to fight infection.
However, it has been designed to target a protein in the liver with the name PCSK9.
And ultimately it makes the organ better at whipping bad cholesterol out of the blood and breaking it down.
The antibody is given by injection into the skin every two to four weeks.