The People's Perspective on Medicine

Who Benefits by Taking Repatha for High Cholesterol?

A reader wonders whether the benefits of Repatha for high cholesterol outweigh the risks. This is a decision that should be made on an individual basis.
Test tube with blood sample for LDL-Cholesterol (LDL-C) test

Unless you have been hiding in a cave, you know that high cholesterol is considered a major risk factor for heart disease and death from cardiovascular complications. We always like to point it that it is not the only cardiovascular risk factor. However, doctors can prescribe a number of medications that lower cholesterol levels, while they have more difficulty addressing other factors. Physicians can’t write prescriptions to control air pollution, for example (Science of the Total Environment, Nov. 3, 2019). Race and sex disparities are just as hard to address (Atherosclerosis, Nov. 1, 2019). Consequently, clinicians are enthusiastic about lowering blood lipids. Many get excited about the prospect of prescribing evolocumab (Repatha) for high cholesterol. How well does it work?

The Evidence on Repatha for High Cholesterol:

Q. Can you tell me about Repatha? Are the people who take it actually helped by it? What about side effects? Is lowering cholesterol worth the risks of taking this?

A. Evolocumab (Repatha) is an injectable medication used to lower LDL cholesterol even more than statins alone. In one study (OSLER-1), volunteers on Repatha lowered their “bad” LDL cholesterol from 140 to 61 mg/dl (Journal of the American College of Cardiology, Oct. 29. 2019).

Lowering cholesterol should not be an end in itself, however. In one major study, people taking Repatha for high cholesterol were less likely to suffer heart attacks or strokes but no less likely to die prematurely (New England Journal of Medicine, May 4, 2017). That’s despite the extraordinarily low levels of LDL that the participants achieved–an average of 30 mg/dl.

Side Effects of Repatha:

Upper respiratory tract infections, including flu, were reported more often by people taking Repatha for high cholesterol. Other side effects may include sore throat, sinusitis, gastroenteritis and injection site reactions. Back pain, muscle pain, dizziness and urinary tract infections are also more common among people on Repatha than in those taking a placebo drug. In the OSLER-1 trial, osteoarthritis, chest pain and angina were serious side effects. Some people developed severe allergic reactions that prevent them from continuing on the medication. Others dropped out out of the study because they were diagnosed with diabetes.

Who Benefits?

Experts suggest that people at the highest risk for heart disease may get the most benefit from Repatha (Current Medicinal Chemistry, online Aug. 27, 2019). The FDA approved its use for people with established heart disease, for those with familial high cholesterol and for individuals who have very high cholesterol. (They call that primary hyperlipidemia.)

You should discuss the pros and cons of this medication with your doctor. If you have heart disease and are at high risk of a heart attack or stroke, this drug might offer benefit.

In some cases, physicians have prescribed this drug (or its competitor Praluent) for people who have not been able to tolerate a statin to lower their high cholesterol. However, in many situations, people take Repatha in combination with a statin or another cholesterol-lowering drug, ezetimibe (Zetia). In summary, you and your doctor will need a thoughtful assessment whether the benefits outweigh the risks for you.

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    About the Author
    Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
    Cholesterol Control & Heart Health
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    Cholesterol Control & Heart Health
    Citations
    • Nhung NTT et al, "Exposure to air pollution and risk of hospitalization for cardiovascular diseases amongst Vietnamese adults: Case-crossover study." Science of the Total Environment, Nov. 3, 2019. DOI: 10.1016/j.scitotenv.2019.134637
    • Hicks CW et al, "Race and sex-based disparities associated with carotid endarterectomy in the Atherosclerosis Risk in Communities (ARIC) study." Atherosclerosis, Nov. 1, 2019. DOI: 10.1016/j.atherosclerosis.2019.10.019
    • Koren MJ et al, "Long-term efficacy and safety of evolocumab in patients with hypercholesterolemia." Journal of the American College of Cardiology, Oct. 29. 2019. DOI: 10.1016/j.jacc.2019.08.1024
    • Sabatine MS et al, "Evolocumab and clinical outcomes in patients with cardiovascular disease." New England Journal of Medicine, May 4, 2017. DOI: 10.1056/NEJMoa1615664
    • Panagiotopoulou O et al, "Dyslipidaemias and cardiovascular disease: Focus on the role of PCSK9 inhibitors." Current Medicinal Chemistry, online Aug. 27, 2019. DOI: 10.2174/0929867326666190827151012
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    My doctor wanted me to start on Repatha. I researched the side effects because I am intolerant to statins, beta-blockers and several high blood pressure medications. I started to read blogs of people taking Repatha. The side effects are terrible. I have two neighbors who are on it, and they both have severe side effects and both have been diagnosed with dementia. Both were very energetic and seemed very happy and healthy before starting on Repatha.

    I was determined to reduce my cholesterol through diet. I cut out all animal products and all oils, and in three months I reduced my cholesterol 46 points. I’m following the Dr. John McDougall diet. Many other good side benefits from the diet: My skin is prettier than it’s been my entire life (67 years old), so much energy, hair and nails grow like crazy, Mentally more alert and weight loss with eating all I want. The only thing I do not like about the diet is it is difficult to go out to eat. You pretty much have to cook at home to avoid all of the oils and animal products that restaurants insist on using even if you ask them not to.

    It has been shown that those who live the longest (Centenarians) have the higher cholesterol levels (250 mg% on average). Now why would you want to lower it by any means when theirs is a significant survival advantage by having a higher serum cholesterol reading. If anything, I would want to raise it if it was low and take plenty of fat-soluble antioxidants to prevent LDL cholesterol oxidation.

    Hilda, this maybe time to check your RX supplement plan, open enrolement, and my earlier comment, $480 for 90 day supply. AARP United Healthcare rx plan does not cover Rap, only Praluent.

    I have familial high cholesterol and am statin-intolerant. My family doctor suggested Repatha, but I was hesitant because of the cost ($1,400 a month). I was advised that my insurance would help, but upon asking for advice from Repatha, I was told that neither my government insurance (aka Medicare) or a private insurance ( my supplemental insurance) would cover the cost. Who can afford $1,400 a month?

    Am a 25-yr survivor of the same affliction; had quad bypass at 44; mother had triple when I was 28 or so. Older brother had sudden heart attack at 55; 3 younger brothers and 1 of 2 older sisters also with heart conditions but not as bad. I have lost track of how many procedures and stents I currently have had. I’m delighted to be here. I’m very active with just a slight tummy, not excessively overweight.

    I, like about 12% of others, form blockages from scar tissue forming in stents that are not treated correctly; will re-form in 1/2 the time from onset, i.e. 18 mo, then 6 mo then 3 month. In July 2019 I had such a problem when earlier procedure only lasted 22mo. Cholesterol shot to 204 and Praluent brought it back to 64, and still on statins. Headed back to my specialist with life saving Brachytherapy. A typical cardiologist is often uneducated about this.

    I get Praluent via Medicare and supplimental Rx plan, 90day supply $480 range. If you are not getting the right answers do research and find doctors that are truly there to help.

    * Be nice, and don't over share. View comment policy^