LDL cholesterol, a known cause of cardiovascular events, can be controlled with “very effective innovative drugs, capable of lowering it by 85%”. Furthermore, thanks to “an administration every 6 months, they also guarantee adherence to the therapy”, which is equally important given that “half of the patients, after a year of treatment with statins, stop taking them”, a condition which can ” triple the risk of an event.” This was stated by Claudio Bilato, director of Cardiology of the hospitals of the Western Vicenza area, national councilor and treasurer of the National Association of hospital cardiologists (Anmco) and regional past president of Anmco, on the occasion of an event in Verona promoted by Novartis. “Obviously these innovative drugs cost more than standard treatment and therefore, in the short term, there is a slight increase in spending. But, in the long term – he specifies – having very effective and very adherent drugs means reducing the large expense associated to cardiovascular disease, which is a direct expense of hospitalization, drugs, treatments, reperfusion, etc., but also indirect, which has an economic impact on the whole of society”. (Video)
Cardiovascular diseases, in fact, “are the leading cause of death in Italy, in Europe and in all Western countries – recalls Bilato – Every year”, mainly due to heart attacks and strokes, “200-250 thousand people die in Italy alone. in Veneto there are around 16-17 thousand”. Atherosclerosis – beyond the multiple risk factors such as “high blood pressure levels, diabetes, cigarette smoking, poor physical activity, high body weight and an inadequate diet – is recognized as the cause of heart attack of the myocardium”. At the origin of atherosclerosis there are in fact high levels of “LDL cholesterol, i.e. that cholesterol which is carried by low-density plasma lipoproteins, commonly called 'bad' and which”, it is well established, “leads to the formation of atheroma and, therefore, of atherosclerosis”.
There is no optimal generic value for LDL cholesterol, because “it depends on the patient's cardiovascular risk – explains the cardiologist – Depending on the risk, we must identify the target to reach. A person with a very low cardiovascular risk may have a value below of 115 mg/dL. A patient who has already had an event – heart attack or stroke, for example – has a very high cardiovascular risk and must keep the LDL cholesterol value below 55 mg/dL and, sometimes, even below 40. A patient who, for example, only has arterial hypertension and has not yet experienced any event can be considered at moderate or high cardiovascular risk. On the other hand, patients who have not yet had a cardiovascular event are at high risk. have type 1 diabetes with complications, or kidney failure.”
To reduce LDL cholesterol, “compared to twenty years ago – continues Bilato – there are formidable drugs. There are drugs which, in combination, allow a reduction of up to 85% of the initial values” and allow the problem of adherence to treatment, i.e. regular intake of therapy, in particular statins. “After a year of treatment – underlines the specialist – approximately 50% of patients no longer take them and, after two years, values reach 70%. It is an extremely important problem because – he clarifies – losing adherence means increase, triple, the risk of a new cardiovascular event”.
In addition to statins, “which we have been using for many years”, we also have “other important drugs for controlling LDL cholesterol: ezetimibe and bempedoic acid – lists the specialist – but also inhibitors of the Pcsk9 protein, which are monoclonal antibodies”. Then there is, recently also available in Italy, “an innovative molecule that inhibits the production of Pcsk9 protein. They are the so-called SiRNA, small interfering RNA”, which act by increasing the liver's ability to eliminate LDL lipoproteins from the blood. “These new SiRna drugs, which silence genes, are certainly very effective – Bilato specifies – because, 'on the top' of standard therapy with statins-ezetimibe, they guarantee a further lowering of at least 50% of LDL cholesterol and therefore, in overall, with treatment, the value is reduced by 85% to 90%”.
Another aspect of the innovative SiRna therapy “concerns the high level of adherence because these drugs – the cardiologist points out – are administered subcutaneously, at six-monthly intervals, so the patient must undergo treatment every six months with a great advantage compared to drugs equally effective, but which require to be taken every day. The fact that administration must be done by a healthcare professional – concludes Bilato – is then a further formidable guarantee with regards to adherence”, and therefore of the reduction of the risk of cardiovascular, especially in those who have already had a heart attack or stroke.
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