On: Part IV of V: statins, ezetimibe, PCSK9 inhibitors, niacin, cholesterol and the brain.

Episode: 23

Date: October 2018

Key Subjects:

• Only drugs proven to reduce both cholesterol and CVD events are the ones that target increasing the clearance of cholesterol by upregulating LDL receptors.
  • Not focused on preventing cholesterol synthesis or absorption, but focused on taking it out of the bloodstream.
• Statins most commonly used drug.
  • Lowers cholesterol synthesis, which in turn activates higher cholesterol clearance.
  • Statin’s impact on improving cholesterol clearance is more powerful than its impact on preventing synthesis.
• Statins may lower synthesis too much (in the brain) in people that have lower cholesterol synthesis to being with.
  • Low cholesterol in the brain is associated with higher risk of neurodegenerative diseases.
  • Important to understand your level of cholesterol synthesis (measure desmosterol).
• Depending on individual situation, may make sense to take low dose statin in combination with other drugs.
  • Ezetimibe (to lower cholesterol absorption).
  • PCSK9 inhibitors (to further increase cholesterol clearance).

Key Takeaways:

• -/-.

Worth Listening:

• 8/10