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A monitor shows a three-dimensional image of a human heart at the Klaus-Tschira Institute for Integrative Cardiology, Department of Heidelberg University Hospital (Universitaetsklinikum Heidelberg), in Heidelberg, Germany on the 14th August 2018. Photo taken on August 14, 2018. 2018. REUTERS / Ralph OrlowskiReuters
(Reuters) – The updated US Heart Health Guidelines recommend a more personalized risk assessment and two new types of cholesterol-lowering drugs for people at particular risk of heart attack or stroke.
The recommendations of the American Heart Association and the American College of Cardiology, last published in 2013, recognize recent research showing the benefits of a very low rate of "bad" LDL cholesterol , which contributes to the formation of fat plaques and narrowing of the arteries.
Medical groups, who announced the guidelines Saturday at the annual meeting of the AHA in Chicago, still insist on a healthy diet and exercise as a first line of defense against heart disease, the leading cause in the country.
When lifestyle does not control cholesterol, patients are generally prescribed statins, available in the form of low-cost generic pills that have been shown to safely and effectively reduce LDL levels and reduce the risk of cholesterol. risk of heart disease.
For people who have had a heart attack or stroke, who are at high risk for another one and whose cholesterol levels are not sufficiently lowered by statins, the guidelines now recommend the addition of new drugs. anticholestérol.
High-risk patients are advised to first try statins in combination with ezetimibe, the generic version of Zetia, which lowers cholesterol by limiting absorption through the intestine. If this does not work, the guidelines recommend new injected drugs, the PCSK9 inhibitors, specifically intended for people at very high risk or suffering from a genetic disease causing very high cholesterol levels.
Two PCSK9 Drugs – Amgen Inc.'s
Repatha and Praluate Partners Regeneron Pharmaceuticals Inc.
and Sanofi SA
– were launched in 2015 at US prices of more than $ 14,000 per year.
Both of these drugs have been shown to significantly reduce cholesterol levels, but their adoption has been slow, with the medical community and health insurers questioning their profitability.
To help boost utilization, Amgen has reduced Repatha's catalog price by 60 percent to $ 5,850 last month, and Praluent's annual net price has been reduced from $ 4,500 to $ 6,600 earlier this year.
The new guidelines are quite "conservative" in recommending that new drugs be used only after other options, said Dr. Francisco Lopez-Jimenez, a cardiologist at the Mayo Clinic in Rochester, Minnesota, adding, "I think it was the right approach."
The guidelines continue to include a calculator introduced in 2013 to identify the 10-year cardiovascular disease risk of a patient. In addition to traditional risk factors such as smoking and high blood pressure, doctors are now encouraged to discuss family history and ethnicity, as well as health issues such as chronic kidney disease and premature menopause.
They are also advised to test cholesterol levels in two-year-olds with a family history of heart disease or high cholesterol, while other children should have an initial test between the ages of 9 and 11. years.
Calcium measurement in the coronary arteries is recommended for people whose risk level is not clear.
The updated guidelines contain more specific recommendations for certain age groups and ethnic groups, as well as for people with diabetes.
(Report by Deena Beasley, edited by Chizu Nomiyama and Marguerita Choy)
Copyright 2018 Thomson Reuters.
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