Heart Disease and Medication Advances: What You Need to Know for Better Heart Health

In America, heart disease is the No. 1 killer of men and women and the leading cause of death for people of most racial and ethnic groups. Heart disease is a bucket term that refers to several types of heart conditions. In the U.S., the most common type of heart disease is coronary artery disease, which is caused by a buildup of fats and cholesterol (known as plaque) in the walls of the arteries. The narrowing of the arteries can lead to blocked blood flow.

In recognition of American Heart Month, our annual reminder to focus on heart disease awareness and prevention, I reached out to Lee Health Heart Institute Cardiologist Karla Quevedo, M.D., FACC, for more information about heart disease and medications, including those that can lower cholesterol.

“When it comes to significant risk factors for heart disease, there are modifiable and non-modifiable risk factors,” Dr. Quevedo explains. “There are things you can change through your lifestyle like high blood pressure (hypertension), high cholesterol (hypercholesterolemia), diabetes, obesity and chronic kidney disease. At the same time, there are some risk factors you can’t change, like your family history, gender or age.”

Dr. Quevedo encourages lifestyle changes, including exercising, quitting smoking, reducing alcohol and eating a healthy, low-salt and low-saturated fat diet. When lifestyle changes alone don’t work, some medications can help.

Statins are one example of a prescription medication that people take to lower their cholesterol, especially the low-density lipoprotein (the LDL, or bad cholesterol), as well as triglycerides. Statins have been available to patients since the 1980s. Though statins are some of the most common prescriptions in America, some patients may have an intolerance to them, or patients may not reach the target LDL with statins alone. Some high or very high-risk patients also may benefit from a combination of statins and other medications.

Talk to your doctor or healthcare provider about the medications that you should take, but there are additional medications available to treat and prevent heart disease.

Bempedoic acid, for example, is a newer medication approved for the treatment of lipid disorders (abnormal levels of cholesterol and triglycerides in the blood). “When used alone, bempedoic acid was shown to lower LDL cholesterol by approximately 30%,” Dr. Quevedo says. “It also significantly reduces the risk of cardiovascular death, non-fatal heart attacks and strokes without increasing the risk of new-onset diabetes.”

Approved for use in 2002, ezetimibe works by inhibiting the intestinal absorption of cholesterol by more than 50%, which contributes to a reduction of LDL cholesterol of approximately 20%. Another option that has been approved for use for nearly 25 years is colesevelam. “This is an option for LDL lowering, and lowers in the range of 15-20%, but requires six tablets daily, which can be a barrier to use,” Dr. Quevedo says.

PCSK9 inhibitors are another medication. “PCSK9 inhibitors are drugs that block the PCSK9 protein, which reduces LDL receptor breakdown and increases their recycling, helping lower LDL cholesterol levels,” Dr. Quevedo explains. “The approved drugs, alirocumab and evolocumab, reduce LDL cholesterol by about 60% alone and up to 85% when combined with high-intensity statins and ezetimibe. PCSK9 inhibitors are generally recommended for patients with a family history of high cholesterol.”

Dr. Quevedo adds that drugs like semaglutide can reduce the risk of heart disease in people with type 2 diabetes and obesity. “These agents have proven to reduce the risk of stroke, heart attack and hospitalization for heart failure, as well as improve lipid profile, reduce plaque formation and protect the kidneys,” she says. “The development of new weight loss medications is a rapidly moving field that can continue to prove benefits in patients with modifiable risk factors for heart disease.”

New advances and research in heart disease continue, and it is exciting to consider what may be on the horizon. It is also promising to see how the right mix of lifestyle changes and medication therapy can impact heart health, longevity and quality of life. To learn more about the Lee Health Heart Institute, visit www.LeeHealth.org/our-services/cardiovascular-services.