The People's Perspective on Medicine

Can Repatha Substitute for Statins to Lower Cholesterol?

Many people tell us they cannot tolerate statin side effects. Will Repatha substitute for statins without side effects and lower cholesterol successfully?

Not everyone can tolerate statins to lower cholesterol. Some people react to drugs like atorvastatin, lovastatin, pravastatin, rosuvastatin or simvastatin with muscle pain and weakness, arthritis, muscle cramps, digestive distress or neuropathy . Others complain of cognitive problems or forgetfulness. Evolocumab (Repatha) has been approved to treat high cholesterol levels together with a statin. But what about all by itself? This reader shares a success story with Repatha alone. Will Repatha substitute for statins?

Repatha Instead of Statins:

Q. I have been plagued with high cholesterol most of my life. Doctors put me on statins and the result was terrible pain and loss of short-term memory.

The statins lowered my cholesterol from the 300s down into the 200s, but the side effects were totally unacceptable. Switching statins and lowering the dosage didn’t help.

My new doctor prescribed Repatha and within six weeks my cholesterol dropped to 107 with no side effects. I have been on Repatha for six months now and can’t say enough about the new treatment.

A. Evolocumab (Repatha) is a relatively new injectable cholesterol-lowering medicine. It is approved for people with heart disease or those who have familial (inherited) super-high cholesterol.

Repatha is usually prescribed together with a statin. However, some doctors are prescribing it for patients who can’t tolerate statin side effects. Is it kosher to have Repatha substitute for statins? There is no good answer. The study published in the New England Journal of Medicine (May 4, 2017) showed that Repatha plus a statin reduced heart attacks, strokes and the need for stents more than placebo plus statin.

Doctors can prescribe medications any way they deem appropriate. The FDA’s “indications” are guidelines or recommendations. Drugs get approval for specific indications based on clinical trials. We cannot tell you how well Repatha works all by itself. How well did Repatha work when combined with a statin?

What About Absolute vs. Relative Risk Reduction?

It is crucial for physicians and patients to understand the difference between relative risk reduction and absolute risk reduction. The FOURIER study published in the New England Journal of Medicine reveals some interesting stats. Remember, this study involved a statin plus Repatha.

The relative risk reduction for a stent, stroke or heart attack was between 21 and 27 percent. Sounds impressive. But the absolute risk reduction was 1.5 out of 100. Confused? Here is an article that explains the pros and cons of Repatha in greater detail and this absolute vs. relative thing.

Does the New Cholesterol Drug Repatha Save Lives?

What About Repatha Side Effects?

Side effects are relatively uncommon. Some people experience serious allergic reactions, flu-like symptoms such as sore throat and cough, back pain, headache, muscle pain, dizziness or digestive distress.

If insurance covers the cost of Repatha, you are fortunate. Otherwise the drug is very expensive. More about cost at this link:

Can You Afford Repatha to Crush Your Cholesterol?

Share your own experience with Repatha below in the comment section.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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I have used Red Rice Yeast (RRY) for the past year and my total Cholesterol, HDL and LDL have been at optimum levels. The prescription Lovastatin worked for me but the side effects were pretty bad. All RRY, however, is not equal. ConsumerLab tested 12 brands and found that only two brands had effective amounts of Lovastatin in a daily dose of two capsules I use Cholestene a HPF product available from Amazon.

I shocked my Dr. by using 3 teaspoons of Vinegar for 30 days prior to my annual physical. It had always been elevated(4 previous years) and he knew I truly detested Statins. When he saw my cholesterol was normal he was surprised to say the least. Asked him if he wanted to know why? He said sure – I told him and his comment was, “that was just incidental”.

Apparently a physician’s only job these days is to be a portal to Big Pharma. (Check the cost of Repatha – $1000.)

Wow! What kind of vinegar did you use? Any special time of day? Oh, and I’d get a new doctor if I were you!! : D

Be aware if a doctor is prescribing a statin based on total cholesterol. One wanted to prescribe it because of a high HDL made the total rather high! When questioned about it, he said, “who’s the Doctor here?” Needless to say I found someone else!

Do you know why there were no clinical trials to test how well Repatha works by itself?

We don’t know; the drug company originally intended it to accompany statin treatment and that is how it has been tested.

My combined cholesterol has been around 230 for years, but my good stuff (HDL) has always been 80 or a bit higher with very good ratios, so my now-retired Dr was not concerned. A subsequent Dr wanted me to take statins to get below 200, but my personal research (e.g., combined 300 may be cause for concern) and good health (active, weight 170-172 lbs at 6 feet, and no prescriptions at age 75) led me to conclude that it was unnecessary if not nuts to run the statin risk. I did, however, begin taking 2 x 500mg flush-free niacin per day about a year ago with no side effects; my most recent combined reading was 199, to which I can attribute only the niacin.

I have tried every Statin made, resulting in many side effects including a healthy lipid profile. The negative side effects were bad including brain fog. But miracles do occur! I now have a normal Lipid profile due to a brand of red yeast rice-plus tablets and Bergamot BPF capsules from an online molecular products store that my doctor recommended. Happy days!!!!

Some who have written about studies and the accuracy of the results would say that these “disappointing results” would put into question the cholesterol theory. In fact Ben Goldacre, MD, in his book reviewing the many limitations of drug studies wrote that such “disappointing results” would be an overall failure and were based on bias. Other studies would have to verify these results. The newspaper headlines that reported on the Repatha study used the relative risk figure.

A cholesterol of 107 would scare me to death! Our bodies need cholesterol.

I agree with Beverly – a cholesterol level of 107 is dangerously low! When mine was down to 134 I experienced muscle deterioration in my upper arms that eventually wore away my rotator cuffs, and severe, suicidal depression. I am angered by articles like this one that assume what we’re being told about cholesterol levels by Big Pharma and mainstream medicine is reliable when there is much evidence that cholesterol levels of 200 and higher result in much better memory retention in the elderly and were considered normal not all that long ago. It’s my opinion that this low cut-off number was chosen by Pfizer, the company that invented Lipitor, to sell more drugs, not to help anyone. The question shouldn’t be about what drugs lower cholesterol, but whether there is any benefit in lowering cholesterol at all, and if so, does the benefit outweigh the dangers?

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