Cholesterol: a new weapon to beat the bad one

The UK challenges the bad cholesterol, the Ldl, in patients at high risk for atherosclerotic cardiovascular disease or ASCVD, which sees the accumulation of Ldl cholesterol inside the plaque as one of the propellants that trigger complications, such as heart attack and stroke. Under the magnifying glass are people with a history of previous events (e.g. myocardial infarction or unstable angina requiring hospitalization, coronary or other arterial revascularization procedures, coronary artery disease, ischemic stroke, or peripheral arterial disease) and that have values ​​persistently higher than 2.6 millimoles / liter, about 100 milligrams per deciliter. For them the target must be lower. And it must be achieved.

The British National Health Service (NHS) partnership with Novartis, as part of a cutting-edge collaboration based on the unique “population health” approach. In fact, the collaboration moves to the implementation phase following the positive recommendation received by the National Institute for Health and Care Excellence (NICE) for the use of inclisiran in general medicine, with very specific recommendations. The drug is indicated for the treatment of adult patients at high risk according to the above criteria, who have persistently elevated LDL-Cholesterol levels (2.6 millimoles / liter or more, despite statin therapy at the maximum tolerated dose with or without ezetimibe. ). Inclisiran is the first and only agent called “siRNA” (small-interfering – RNA) able to reduce the levels of “bad” or Ldl cholesterol by interfering with messenger RNA. It works in a complementary way to statins at the maximum tolerated dose and a lipid-lowering diet, preventing the production of the target protein in the liver, increasing the absorption by the liver of LDL and eliminating it from the bloodstream. Inclisiran is given in an initial dose, again after three months and then only twice a year with a subcutaneous injection given by a healthcare professional. Clinical studies show that thanks to this treatment it is possible to maintain a reduction in LDL cholesterol in the periods between the different administrations.

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The partnership between Novartis and the NHS, which develops through collaboration with the NHS Accelerated Access Collaborative and the Academic Health Science Network (with the support of NHS Digital), aims to help proactively identify, treat and monitor people with ASCVD (the acronym stands for atherosclerotic cardiovascular disease, a condition that appears to be linked to over 85% of all deaths from diseases of this type), which have already had an event and must therefore achieve specific objectives of the Ldl. According to forecasts, in three years there should be about 300,000 subjects to be treated with inclisiran because they are at high cardiovascular risk. “This approach to population health management is potentially revolutionary, as it seeks to improve the health of a nation by proactively identifying individuals” at highest risk “, and to introduce effective solutions that will improve their future health. . This represents a significant advance in patient care through effective management of dyslipidemias – is the commentary of Kausik Ray, Professor of Public Health at Imperial College London and honorary consultant cardiologist at Imperial College NHS Trust. “As a physician, I see many patients whose cholesterol levels are not sufficiently controlled for their level of risk, often despite the optimal use of available therapies, which puts them at an increased risk of heart attack or stroke. Have faster and wider access to a drug like inclisiran, which offers both a maintenance dosage twice a year, and the ability to be used in “Primary Care”, where most patients are treated, as well as ensuring a sustained reduction in LDL-C levels is an extremely positive step in patient care. ” “Cardiovascular disease has long been the number one cause of mortality and this unsolved problem requires re-imagining the way we deal with heart health” – he points out. Vas Narasimhan, CEO of Novartis. “This pioneering collaboration with the UK NHS has the potential to spur a radical change in cardiovascular health in the UK and confirms Novartis’ commitment to working with healthcare systems around the world to improve patient outcomes. , creating together new access solutions for innovative medicines. ”