What If a Statin Isn't Enough? Treating High LDL Cholesterol With a PCSK9 Inhibitor

This activity is for people who have high levels of low-density lipoprotein (LDL) cholesterol, or their care partners, as well as others who want to learn more about managing LDL cholesterol levels. The goal is to help you understand more about the treatment of high LDL cholesterol levels and how you can work with your healthcare providers to get the treatment you need.

You will learn:

• Why high LDL cholesterol is dangerous for your heart heath

• How statins and PCSK9 inhibitors can help manage LDL cholesterol levels

• Whether a PCSK9 inhibitor might be right for you

• How your pharmacist and doctor can provide you with information that can help lower the cost of PCSK9 inhibitors

Cholesterol is a waxy, fat-like substance.

When there is too much LDL cholesterol in your blood, it can build up and start forming "plaques" on the walls of your arteries. This causes the arteries to narrow (atherosclerosis), which slows down the flow of blood to your heart, causing heart disease.

When your arteries become too narrow, the blood supply to your heart may be blocked. This can cause chest pain (angina), heart attack, or stroke.

You can lower your LDL cholesterol levels through a combination of lifestyle changes and medicines.

Lifestyle changes include a healthy diet, exercise, weight loss, and stopping smoking, if needed.

Your doctor will most likely prescribe a medicine called a statin to lower your cholesterol levels. If your LDL cholesterol levels stay high, even with a maximum dose of statin, your doctor may prescribe additional medicines for you, such as ezetimibe and PCSK9 inhibitors.

Statins work by blocking an enzyme that your liver cells need to make cholesterol. This causes your LDL cholesterol levels to go down.

Your doctor may recommend a statin if you have atherosclerosis (narrowed arteries due to plaque) or a risk factor that increases your chances of developing plaques:

• High LDL cholesterol level

• Diabetes

• High blood pressure

• Smoking now or in the past

• High triglycerides and low high-density lipoprotein (HDL) cholesterol levels

All statins are pills you swallow.

Like all medicines, statins can have side effects. The most common ones are muscle weakness, cramping, or pain. Other potential side effects of statins include:

• Liver damage

• Confusion

• Memory loss

• Increase in blood sugar

• Kidney damage

Some patients may need to stop taking statins due to side effects.

Sometimes a statin alone may not lower LDL levels enough, and additional medicine, such as a PCSK9 inhibitor, may be necessary.

There are 2 PCSK9 inhibitors that can help lower LDL cholesterol levels:

• Alirocumab (Praluent^®)

• Evolocumab (Repatha^®)

PCSK9 inhibitors work by making sure that one of the ways your body removes LDL cholesterol from your blood can continue to work properly.

PCSK9 inhibitors are given as a shot every 2 weeks or once a month. Your doctor will show you how to give yourself the shot using a pre-filled pen.

Your doctor may prescribe a PCSK9 inhibitor if you:

• Have familial hypercholesterolemia, a genetic disease that runs in families and causes high LDL cholesterol

• Are at risk for a stroke or heart attack

• Have heart disease or have had a heart attack or stroke, and your LDL cholesterol levels are still fairly high, even though you have been taking a statin

• Have tried several statins but still have high LDL cholesterol levels

• Cannot take other medicines (such as statins or ezetimibe)

Alirocumab should be taken with a statin. Evolocumab can be taken with or without statin.

The side effects are usually mild. They include back pain and symptoms similar to those of a cold or the flu.

Because PCSK9 inhibitors are given as a shot, you might have a little redness, burning, or pain at the place where you gave yourself the shot.

You should contact your doctor immediately or seek emergency care if you have trouble breathing or swallowing, severe rash or itching, or swelling of the face.

PCSK9 inhibitors are expensive. In the past, they have cost about $14,000 a year. This made it difficult for patients to afford the medicine. Most insurance companies would not approve doctors to prescribe the medicines because of the high cost.

The prices for these medicines have recently come down to about $4500 to $8000 a year. This is good news, but without additional help, the cost may still be too high for some patients.

Prescriptions for PCSK9 inhibitors are now covered by most health insurance companies, as well as Medicare Part D. Some patients may also be eligible for financial assistance through special benefit programs.

You can ask your pharmacist or doctor if there is a benefit program that can help with the cost. Your eligibility for assistance may depend on the type of insurance you have, and there may be limits to the total amount of assistance per year. Make sure your insurance information is up-to-date when talking to your pharmacist or doctor.

• What type of medicines can help me lower my LDL cholesterol?

• What is a statin?

• What about ezetimibe?

• What is a PCSK9 inhibitor?

• Are there side effects I should know about?

• Does my insurance cover the cost of a PSCK9 inhibitor?

• Are there any special programs to help me with the cost of my medicines?

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