Dr. Wy, why can’t I take a medication other than a statin to prevent strokes and heart attacks?

Ask Dr. Wy…

Richard Wyderski, MD, FACP

Dr. Wy, why can’t I take a medication other than a statin to prevent strokes and heart attacks?

I’ve recently written articles about calculating heart attack and stroke risk to decide whether to start statin treatment to reduce the risk. But not everyone can take statins due to side effects, some of which can be serious. What do we do then?

While statins are the mainstay of cholesterol lowering medications, there are alternatives that have been proven to reduce heart attack and stroke risk in people who have never had one. This proof is important, because some drugs like niacin and clofibrate, while making the LDL LEVEL better, didn’t reduce that risk and are no longer used. Some OTC supplements can also reduce LDL but lack proof they reduce risk.

Repatha is an injectable drug that allows the liver to much more effectively clear out LDL from the bloodstream, lowering the level by 50% or more. In a trial comparing it to placebo, that translated into a 20% risk reduction for people in general, and over a 30% reduction in high-risk diabetics. Nexletol inhibits LDL from ever forming to reduce the level AND heart attack risk by about 25%. When combined with the drug ezetimibe it can reduce LDL by almost 40%, but there are no studies on how much they reduce risk when used together.

Do remember that these are medications that have been proven to work in people who have never had their first heart attack or stroke. Even more proven options are available for people who have already had one. We need all the stroke and heart attack prevention we can get!

 

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