LDL cholesterol blood

There’s a new cholesterol-lowering medicine making waves. Many health professionals are convinced that there is no such thing as too low a golf score or a cholesterol level. They are right about golf, but we’re not so sure about cholesterol. The FDA approved Repatha to lower LDL cholesterol in 2015. It is starting to catch on with doctors and patients. How good is the evidence it will save lives and what are the potential complications?

The FDA Guidelines (Indications) for Use of Repatha (Evolocumab):

Gird your loins! We are about to pass through the looking glass of FDAspeak. We usually do not like to quote the technical language the FDA requires on drug labels. That’s because it is hard to understand. This is worse than usual, but it is important, so please bear with with us. It was changed on December 1, 2017:


  • “to reduce the risk of myocardial infarction, stroke, and coronary
    revascularization in adults with established cardiovascular disease. (1.1)
  • “as an adjunct to diet, alone or in combination with other lipid-lowering therapies (e.g., statins, ezetimibe), for treatment of adults with primary hyperlipidemia (including heterozygous familial hypercholesterolemia) to reduce low-density lipoprotein cholesterol (LDL-C). (1.2)
  • “as an adjunct to diet and other LDL-lowering therapies (e.g., statins,
    ezetimibe, LDL apheresis) in patients with homozygous familial hypercholesterolemia (HoFH) who require additional lowering of LDL-C. (1.3)”

What the FDAspeak Means:

We interpret the official “indications” for evolocumab above to mean that when diet and other cholesterol-lowering treatments (like high-dose statin therapy) don’t achieve the desired results, then Repatha to lower LDL cholesterol might be added to the mix. This would be for people diagnosed with familial hypercholesterolemia or atherosclerotic cardiovascular disease. Your average Joe with elevated LDL cholesterol would not be included in these official indications, unless he has diagnosed cardiovascular disease.

Please note that the FDA used to require the company to state that the ability of the drug to prolong life “has not been determined.” That was dropped when the labeling was changed in December, 2017.

TV Commercial For Repatha to Lower LDL Cholesterol:

Have you seen the television commercial for Repatha to lower LDL cholesterol? An announcer asks:

“Working hard to lower your LDL bad cholesterol? Not making enough progress? You eat well. Take the highest dose statin you can, but still aren’t getting where you need to be. Now there’s Repatha, a different way to reduce LDL and get on the path to dramatically lower numbers.”

The video shows a man pedaling a bicycle downhill as fast as he can but making very little progress. Other people go zipping by at normal speed. One guy looks disdainfully at our frustrated bike rider as he passes by. Another fellow is shown trying to slowly walk down the up escalator. People go past him fast on the down escalator.

Later we see our bike rider going down hill at a normal clip and our escalator walker moving fast on the down escalator. Presumably, they are modeling downward progress thanks to Repatha to lower LDL cholesterol. See the commercial yourself at this link.

We may have missed it, but nowhere in the commercial did we see or hear reference to the FDA approved indications. In other words, neither familial hypercholesterolemia nor clinical atherosclerotic cardiovascular disease were mentioned. Our average Joe might assume that Repatha to lower LDL cholesterol might be just the ticket. He just might follow the announcer’s suggestion to “ask if Repatha can you get on the path to way lower LDL.”

Commercials Work:

Drug companies would not spend big bucks making television commercials and buying air time if they didn’t work. Here is a question we received from a reader:

Q. There is a strong possibility that my husband and I might need to start taking the new product called Repatha to lower LDL cholesterol. We have read some disturbing reviews about the side effects of this drug. In addition, the cost is almost prohibitive. Can you please shed some light on this new drug?

A. The injectable drug Repatha (evolocumab) was approved by the FDA in 2015 for people with very high cholesterol that runs in the family. It is supposed to be used with statins or other cholesterol-lowering drugs. Some doctors are beginning to prescribe Repatha for people who can’t tolerate statins, however.

Repatha (Evolocumab) Side Effects:

Side effects may include infections of the respiratory system or urinary tract. Some people also experience headache, dizziness, cough, back pain, muscle pain or reactions at the injection site. Life-threatening allergic reactions are the most serious complication.

The Repatha website lists this Important Safety Information:

“What are the possible side effects of Repatha®?

“Repatha® can cause serious side effects including: Repatha® may cause allergic reactions that can be serious. Call your healthcare provider or go to the nearest hospital emergency room right away if you have any symptoms of an allergic reaction including a severe rash, redness, severe itching, a swollen face, or trouble breathing.

“The most common side effects of Repatha® include: runny nose, sore throat, symptoms of the common cold, flu or flu-like symptoms, back pain, high blood sugar levels (diabetes), and redness, pain, or bruising at the injection site.

“Tell your healthcare provider if you have any side effect that bothers you or that does not go away.

“These are not all the possible side effects of Repatha®. Ask your healthcare provider or pharmacist for more information. Call your healthcare provider for medical advice about side effects.”

“You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

The High Cost of Repatha:

If your insurance company won’t cover Repatha, you may end up spending at least $1,200 a month each.

Here is what some readers have to say:

JuneBug 14 offered this perspective:

“I looked up Repatha and the mortality rate is the same as NOT taking it. Insurance won’t pay for it, and why would I put my family through that expense?”

Steven in Georgia is caught in a bind:

“I have tried many statin-type cholesterol-lowering drugs through my doctor to no avail. Every one of them gave me severe muscle pain. Repatha became available and I got on the trials of that. This drug knocked my numbers down from my 290-300 to barley 100 or so. But after months of trying, my doctor could not get my insurance company to approve it.

“He sent me to a cardiologist to see if he could get my insurance company to approve it. The cardiologist started me on Praluent, a somewhat similar drug. I tried it a couple of times and it just made me feel different. That’s about the best description I can give on that. Then my muscles started hurting again…Needless to say, I stopped using it. Now I am on the road to a natural fix for my cholesterol.”

A Message from Danish Physician, Uffe Ravnskov:

A renowned cholesterol skeptic and author of The Cholesterol Myths, Uffe Ravnskov, MD, PhD, wrote this on our website on April 18, 2017:

“The Repatha trial was originally planned to go on for 4 years, but as the number of heart events was significantly lower in the treatment group already after 26 months, the authors decided to stop the trial.

“But the number of deaths, both from heart disease and from other causes, had increased! Not with statistical significance, but it might have become significant if the trial had continued. A relevant question is therefore: Did they stop the trial because the total number of events had become significantly lower in the treatment group, or because the number of deaths was increasing?

“How do they explain that 444 died in the treatment group, but only 426 among the untreated? I mean, if ‘bad’ high LDL-cholesterol was the cause of atherosclerosis and heart disease, then we should expect that a 59% lowering of this ‘poisonous’ molecule should lower mortality, not increase it.

“The reason is of course that a high level of LDL-cholesterol is not poisonous; it is beneficial, as we have documented in a review of 19 studies including more than 68,000 people above the age of 60 published in BMJ Open (http://bmjopen.bmj.com/content/bmjopen/6/6/e010401.full.pdf). Almost all studies found that elderly people with the highest levels of the ‘bad’ LDL-cholesterol live the longest; even longer than those on statin treatment; no study found the opposite. A reasonable question is therefore: Why should we lower the bad cholesterol if those with the highest values live the longest?”

What’s Your Experience with Repatha to lower LDL Cholesterol?

We would love to know more about how people are faring with Repatha or Praluent. Share your story below in the comment section.

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  1. Rose D

    Still no answer to the question of will side effects lessen if you stop the Repatha??

  2. George

    2-3 days after my injections I have had general malaise and headaches for several days. So far I have only taken 3 injections. Will monitor to see if this goes away. Also similar, but so far less troublesome muscle issues are evident.

  3. Marilyn
    Kensington, MD

    A couple of comments. Amgen requested revisions to the indications based on the results of the FOURIER trial. The first indication does not include a reduction in cardiovascular death. That is because cardiovascular death was not reduced in the FOURIER trial. In addition, all cause mortality was not reduced, in fact all cause mortality was nonsignificantly higher in the Repatha group than in the placebo group. The investigators will be following up the trial participants to try to see what effects will emerge over time. In addition, there is another PCSK9 inhibitor, Praluent (alirocumab), for which the outcomes trial is still underway, which may give us additional information as to the effects of PCSK9 inhibition on cardiovascular death and all cause death.

    The FOURIER trial was an “event driven” trial that was designed to continue until at least 1630 patients experienced the key secondary endpoint of cardiovascular death, myocardial infarction (heart attack) or stroke. The trial was stopped when that number of secondary endpoints was reached. I see no reason to read any other motive into the timing of the trial termination.

    The term “familial hypercholesterolemia” refers to a monogenic disorder characterized by elevated LDL. The term “primary hyperlipidemia” includes genetic lipid disorders other than familial hypercholesterolemia, such as familial combined hyperlipidemia, polygenic hypercholesterolemia, and familial hypertriglyceridemia. Therefore, I do not see the second indication as limited to persons with familial hypercholesterolemia. This is evident from the language used, i.e., “primary hyperlipidemia (including familial hypercholesterolemia).”

    Currently, there are strict preauthorization policies that are limiting the number of people who are using Repatha and Praluent. Even people with FH or clinical cardiovascular disease are having their requests turned down by their insurance companies (about 47% approval rate in the first year). The main reason for the strict preauthorization policies is the cost of these drugs. There are also quite a few people who simply can’t afford the cost-sharing in the form of deductibles and copays.

  4. Betty

    Just my own thought, no studies to back it up. Since the brain needs cholesterol to function, so many are on statins, and alzheimer rates are soaring. Could there be a connection here? People take a pill, then do not change their diet and sit all day.

  5. Colorado Conservative

    So pleased I read this article prior to my upcoming annual visit. My “bad” LDL levels are elevated and the doctor wants me to take statin drugs. I refuse to do it for several reasons: the association of dementia and falls with those on statin drugs, tried taking Red Yeast Rice (alternative to statins) and had horrible muscle cramps/weakness, and the fact that I take quite a bit of fish oil which I read increases the bad LDL. Appreciated the quote from the Danish physician who wrote The Cholesterol Myths.

  6. Prentice

    My cholesterol levels were above 230 when I first started Repatha. I had a problem statin drugs for a few years prior so my doctor thought it might be a good treatment. It took six months to get approval from the insurance company. My LDL is now below 40 with no noticable side effects.

  7. Susan

    Praluent is another medication similar to Repatha, namely, both are human monoclonal antibodies designed to lower LDL (“bad” cholesterol) by blocking a protein (called PCSK9), which may contribute to high levels of LDL.

    I wonder whether the FDA clinical trial information you provide about Repatha also applies to Praluent clinical trials, namely, that study participants on Praluent also lowered their LDL but did not necessarily live longer than those in the control group and may actually have had a lower survival rate than the control group?

    Any information about this would be appreciated, as my husband has been prescribed Praluent “off label” to try to prevent recurrent strokes.

    Thank you.

  8. Kathleen K
    San Antonio

    I had taken any and all statin drugs – tried them all! Finally my cardiologist suggested Repatha – I have injected it twice now and have had no side effects. I look forward to my cholesterol being in the normal range. As far as the price – Repatha has a discount card and I only pay $5 – of course my insurance did approve it.

  9. Nikki E
    Decatur, GA

    Wi began takng Repatha 3 years ago when my total cholesterol level was 400. My current total cholesterol is 155, which is terrific. My glucose levels remain stable and under the pre-diabetic levels, and my triglycerides are well within the normal range. I had previosly been treated with an aray of statins, which resulted in severe muscle pain throughout my body. Taking Repatha has not resulted in this side effect for me.
    I enjoy and appreciate Graedon’s Pharmacy. Thank you.

  10. Tom M

    Thanks for reminding me why I don’t watch TV. As far as I am concerned, heart problems are caused by sugar. We have been lied to for over 50 years. Is there any reason I should believe the FDA now? NONE!

  11. Carol

    I think a vegan diet is the way to go. There is a learning curve, but the results for the whole body and how you feel is amazing. I recommend nutritionfacts.org to get started with his daily dozen. He reads all the medical journal and studies and puts the facts in a YouTube videos. Try it.

  12. Bill

    My experience has been good; I have had no side effects that I seem to be caused by the drug and the muscle pain has all but stopped.

  13. Bill

    My experience has been good; i have had no side effects that i seem to be caused by the drug and the muscle pain has all but stopped

  14. Marla

    If Repatha is an injected drug and you have bothersome side effects from the drug how do you get the drug out of your system to alleviate the side effects? Do you just have to deal with the side effects for two – four weeks until it’s time to take the next dose? I wouldn’t want to deal with an allergic reaction or some of the other side effects for weeks.
    Thank you People’s Pharmacy for making us aware of information such as this.

  15. Jeanie

    Thank you for this insightful information on Repatha. My doctor recently mentioned this drug in an annual visit. Since my body won’t tolerate satins, he thought it would be a good alternative to lower my LDL and was receiving good reviews. My HDL, triglycerides and ratio are all above the normal range. I doubt seriously I would take this drug.

  16. Jack
    Garland, TX

    I am caught in the middle. I have Barretts Esophagus and have been on Omprazole for a long time. My doctor said that Barretts can lead to Esophagus cancer which is deadly.

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