New cholesterol-lowering drugs in tablet form or as an injection
Many people with elevated blood fat levels are prescribed tried and tested medications, so-called statins. They can demonstrably lower elevated blood lipid levels, such as cholesterol, and prevent dangerous secondary diseases such as heart attacks and strokes.
There are also newer drugs called Alirocumab, Evolocumab, Ezetimibe and Inclisiran. Ezetimibe is available in the form of tablets, the preparations are called Ezetad, Ezetrol or Ezetimibe-Ratiopharm. The other three active ingredients are injected under the names Praluent (alirocumab), Repatha (evolocumab) and Leqvio (inclisiran).
Analysis considers benefit versus risk
Do the newer drugs have benefits – in addition to statins or as an alternative drug? An international research team has evaluated studies on this. The analysis is in British Medical Journal appeared and describes the benefit of blood lipid lowering drugs depending on the initial risk for cardiovascular events such as a heart attack. This risk is very low in a patient who has high cholesterol but no other risk factors. The initial risk is very high, for example, in a patient who has had a heart attack.
Little benefit – and only at high risk
The results of the evaluation are modest:
- When the newer blood-fat-lowering drugs are given in addition to statins, they cannot reduce the rate of deaths overall and specifically from heart attacks or strokes. This applies regardless of the initial risk.
- The risk of non-fatal heart attacks and strokes could decrease slightly – but only in people with a high or very high risk at baseline. Over a five-year period, the newer blood-fat-lowering drugs would prevent about 1 to 2 in 100 more such incidents than statins alone. For ezetimibe, the result probably only applies to strokes.
- The benefit of using the newer drugs instead of statins is similarly small, for example if statins are not tolerated by users. However, these calculations are based on comparatively little data.
- In addition, the analysis summarizes the results for alirocumab, evolocumab and inclisiran. It is questionable whether they actually also apply to inclisiran. Because so far there are no study results on the active ingredient that show whether it prevents heart attacks or strokes.
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Our rating is also negative
Two of the four drugs included – ezetimibe and evolocumab – are evaluated in our Drugs Under Review database. We classify both as unsuitable – either alone or in combination with a statin. Accordingly, only special groups with a high cardiovascular risk can benefit from the application.
Statins, on the other hand, we rate as suitable. Their benefits are well documented and practical use has been tried and tested over many years.
Tipp: In a discussion with the doctor, it can be clarified whether medication for elevated blood lipid levels is necessary at all. If so, active ingredients from the group of statins are standard therapy and well tolerated by most people. Sometimes there are side effects such as muscle pain. Sometimes it helps to reduce the dose or switch to a different preparation after consulting a doctor. According to recent studies, muscle complaints are often not caused by statins – but because users expect negative consequences.