How a new pill may be changing the game when it comes to cholesterol

You’ve probably heard before that you need to keep an eye on your LDL cholesterol. For those with persistent problems lowering cholesterol levels, there’s a new treatment option in town.

Cardiologist Devin Haddad, MD, walked us through the new cholesterol pill, including how it works, what makes it different and when it’s likely to become available.

Why is high cholesterol a problem?

“Cholesterol, a type of lipid necessary for building cell membranes, hormones and more, cannot float freely through the blood,” said Dr. Haddad. “It’s transported from place to place inside of particles called lipoproteins, specifically ApoB particles.”

Having high amounts of cholesterol-carrying lipoproteins within the blood stream leads to cholesterol delivery into artery walls and ultimately plaque formation, affecting the development of severe conditions like heart attacks, strokes and peripheral artery disease.

Treatment options for high cholesterol

“We’re fortunate to have a variety of wonderful treatment options to cut down on LDL-cholesterol levels,” said Dr. Haddad. “Statins, for one, are some of the best studied medications in the world and are both very safe and effective.”

For those who don’t see enough improvement through lifestyle changes and statins alone, or who experience side effects with the use of statins, there are other options as well. Non-statin pill medication options for high cholesterol include bempedoic acid, ezetimibe, fenofibrate and more. There are also subcutaneous injection options, called PCSK9 inhibitors, which have increased in popularity thanks to their potency and convenience.

How does the new cholesterol pill work?

“The new cholesterol pill is called enlicitide, or Lipfendra,” said Dr. Haddad. “It’s a once-a-day oral PCSK9 inhibitor. Essentially, the particles in your blood that carry cholesterol are removed from the blood stream by LDL receptors present in liver cells. Since PCSK9 is a protein involved in breaking down LDL receptors, taking a PCSK9 inhibitor allows more LDL receptors to remove cholesterol containing particles from the blood stream.”

While the injectable form of inhibitors is effective and safe, some patients are less comfortable with the idea of long-term routine injections. For them, the new cholesterol pill enlicitide offers an alternative option.

Clinical trials have shown similar LDL-cholesterol and ApoB particle lowering effects when compared to injectables.

Who may benefit from using enlicitide?

“The people who will benefit from enlicitide are those who have not been able to lower their LDL-cholesterol or ApoB particle levels enough through lifestyle intervention plus traditional lipid lowering medications or those who experienced clinically significant side effects to standard lipid lowering therapy,” said Dr. Haddad.

Speaking with your doctor can help you to understand whether enlicitide would be a good option for you.

Are there any potential risks or side effects to be aware of?

“In the major clinical trials to date, the rates of adverse events weren’t significantly different in patients receiving enlicitide and those receiving a placebo,” said Dr. Haddad. “This means, so far, that no major risks or side effects have been identified.”

However, if you do experience potential side effects, you should discuss this with your doctor.

When is enlicitide likely to become widely available? 

“With FDA approval, we anticipate that enlicitide will be commercially available soon,” said Dr. Haddad. “FDA approval does not guarantee that a medication will be covered by insurance for everyone, so affordability will still be a key consideration.”

Managing cholesterol levels through lifestyle

The first steps to managing LDL-cholesterol and ApoB particle levels are the same building blocks of better health you’ve likely heard of for so many conditions – diet and exercise.

Dietary considerations include adequate healthy protein sources and focusing on eating more fruits, vegetables, whole grains and replacing saturated fats with mono and polyunsaturated fats whenever possible.

Exercise recommendations include a blend of both aerobic activities and routine resistance training. Depending on a person’s genetics, commitment and risk, they may or may not be able to reach their targets levels with lifestyle intervention alone.

“For many people, diet and exercise simply aren’t enough to lower their levels within the target range,” said Dr. Haddad. “In those cases, medication alongside ongoing diet and exercise changes become an important piece of the treatment plan.”

Your doctor can work with you to understand your individual risk factors when it comes to the potential for heart disease, as well as how well medication might help to lower your LDL cholesterol and ApoB levels.

“Treatments are always the most effective when you and your doctor are working together and are flexible to try different approaches,” said Dr. Haddad. “In the vast majority of cases we can find a reasonable, sustainable and successful plan.”