On: Part IV of V: statins, ezetimibe, PCSK9 inhibitors, niacin, cholesterol and the brain.
Date: October 2018
- 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).