A recent study has suggested that it might be possible to target other areas to lower cholesterol. Specifically, rather than aiming to inhibit one of the key proteins once they are in the LDL receptors, the idea is to address the transport mechanism that ensures that the protein reaches the LDL receptors in the first place.

The study, which was published in eLife, follows a string of previous studies that have aimed to see what happens once the so-called SEC24A gene gets de-activated in mice. The current study is particularly intriguing as it takes the research one step further. Specifically, rather than just focusing on deactivating the gene, the researchers also sought to block vesicles from reaching LDL receptors. In order to do so, they isolated the so-called PCSK9 protein, which usually works by destroying the liver cells receptors of LDL (low-density lipoprotein). The key findings indicated that the mice developed normally, but that their plasma cholesterol levels had decreased by 45 per cent. Based on this, the researchers urged that there be trials with humans to establish whether a treatment can be made.

We can certainly understand why the researchers would want this, as there are some patients who are resistant to statins or cannot take them because of medical contraindications who would benefit from an alternative treatment. Perhaps it could even be used as a complement to optimise treatment for patients who are using statins. Alternatively, it could develop into an alternative treatment that patients could have as a result of informed choice.

Although the findings sound promising, we would caution against any overly optimistic conclusions at this stage. It is clear that extensive long-lasting studies with humans need to be carried out. However, the progress from animal study to clinical trial to market is time-consuming, expensive and not always fruitful. Nevertheless, it is safe to say that the findings from this study can at the very least prove fruitful to guide further theorising.

In medicine, it is not uncommon to use the same type of medicine for different diseases. In fact, there is an entire line of research dedicated to investigating how to make old treatments suitable for new diseases. One area that has been receiving particular attention recently is the use of cholesterol-lowering drugs for various eye-disorders.

According to a recently published study, there is potential for cholesterol treatment (in the form of eye-drops) to prevent macular degeneration. It is known that high cholesterol has an effect on the immune system, which in turn appears to affect various stages of macular degeneration. Essentially, macular degeneration occurs as a result of light-sensing cells becoming damaged. Following that, it can progress to a more aggressive form where new blood vessels can cause blindness. The former is known as the dry version, whereas the latter is known as the wet version.

In the study, which was published in the journal Cell Metabolism, the researchers investigated the evolution from the dry version to the wet version of macular degeneration. All of their research was conducted on animal models. Their surprising finding indicated that the so-called macrophages played a key role in worsening the condition. Rather than protecting blood cells by eating fatty deposits and returning them to the blood, they became “bloated”. As a result the area would get inflamed, which in turn necessitated the creation of new blood vessels. Given that blood fats cause hardened blood arteries, the researchers urged for future studies to consider whether it is possible to use cholesterol-lowering eye-drops to prevent or reduce the generation of fat around the macula. This news was cautiously welcomed by several charities for visually impaired individuals who maintained that the findings are in their early stages.

We are inclined to agree. Although the consequences of macular degeneration are undesirable, we see little research to date to leap to developing treatments based on a handful of studies. Nevertheless, it has opened up a pathway worth investigating and we do hope that it proves fruitful.

A new treatment to lower so-called bad cholesterol is currently being developed in the US and promising findings were recently reported at the American Heart Association Scientific Sessions 2012. The treatment, which is currently called AMG-146, works by helping the body to use up bad cholesterol faster than it normally does. The aim is to have it used in combination with statins, which work by slowing the production of bad cholesterol.

The latest trial, which was published in The Lancet, was a double-blind dose-ranging trial that included a total of 631 individuals between the ages of 18-80. In order to be included, the participants had to have a reported history of high cholesterol while taking a single dose of statins. In total there were six different dosages and six placebos that the participant could be given during a three month period. The treatment or placebo was injected under the skin either every two weeks or every four weeks. The key findings indicated that participants who received the active ingredient treatment showed a reduction in LDL cholesterol compared with the control group. Moreover, the patients who had been given the treatment every two weeks showed a larger decrease (66%) in bad cholesterol than the patients that had been received the injection every four weeks (50%). It is also worth mentioning that no side effects were reported during the study. However, this is not to say that side effects may be noticed during an extended trial.

Overall, it can be noted that the study was small scale and that further trials with more participants and more extensive criteria should be conducted. Moreover, experts have expressed concerns that the treatment may be of limited use if it is injected.

As a result of recent research carried out at Oxford University, it has been suggested that the NHS treatment guidelines should change and that as part of the policy, 20 million people should be prescribed statins such as Crestor. Currently those with a one in five chance of heart attack within the next decade are prescribed cholesterol treatment in the form of statins. This does however include 50% of men over the age of 50 and one third of women of this age. It is now suggested that this pool should expand.

The findings, which have spurred on the idea or rather reignited previous arguments in favour of the use of statins for the over 50s, include the discovery that the risk of heart attack and stroke is decreased by one fifth in those who do not have heart disease and who take statins on a precautionary basis. Expanding the number of people who take the cholesterol treatment is estimated to cost the NHS £240 million.

This might seem like an expensive plan however the money that will be saved can be significant. Savings will include the elimination of screening tests in order to pick out those at risk and in need of treatment. In addition, expensive operations will be reduced and there will be fewer hospital admissions and less spent on medication for cardiovascular illnesses. Since half of all cardiovascular events occur in those who have no previous issues and who were not deemed at risk, it must be a good idea to start preventing such heart related illnesses now.

The study revealed that those with the lowest risk (and taking statins) reduced their risk of death by heart attack or stroke by 15%.

The debate is on-going about whether or not taking statins puts our health at risk but there is no evidence out there to suggest that the risks in any way outweigh the benefits. It is unlikely that this suggestion will be taken up by the NHS in the short term but we believe that there is a strong likelihood that we will be moving in this direction.

Pfizer is supposedly hoping to sell its popular statin, Lipitor, over the counter in the USA but would first need the approval of the Food and Drug Administration in the United States. This speculation comes at a time when the company’s patent is about to run out and before generic versions emerge at the end of this year. It is said that making Lipitor an over the counter drug would help the company retain its profits after the patent expires.

Some physicians are happy about how much more accessible the drug will be to patients and others feel very strongly that this is a drug that should only be taken under medical supervision. Possible side effects include damage to the liver and muscle degeneration, so regular monitoring is imperative. The possibility of experiencing such side effects is small however.

People look forward to dodging the doctor’s fee, which in the States can be very expensive even if one is requesting a repeat prescription, but is it worth the risk? Statins are, in the main, prescription treatments here in Europe and should only be taken under the supervision of a doctor. A low dose version of simvastatin is available over the counter from a pharmacy in the UK but this was a very controversial move at the time.