Dr. Pam R. Taub talks with Diabetes in Control Publisher Steve Freed at the 2016 AACE Meeting. In part 2 of this Exclusive Interview, Dr. Taub explains the use and effects of the latest cholesterol drugs, PCSK9-inhibitors.
Dr. Pam R. Taub, MD, FACC is a board-certified cardiologist who focuses on general and preventive cardiology. As a general cardiologist, she works with patients to diagnose and prevent heart disease, as well as manage conditions such as hypertension (high blood pressure), diabetes, coronary artery disease, or heart failure. Her own research—focused on how epicatechin (a compound found in dark chocolate) can improve mitochondrial structure and exercise capacity in patients with heart failure and diabetes—has received funding from the National Institutes of Health and the American College of Cardiology, and has resulted in multiple publications in top journals. She is also developing and testing new biomarkers (blood tests) to predict cardiovascular risk, as well as studying the mechanisms of statin-related muscle complaints and decreases in exercise capacity and using epicatechin to treat them.
Transcript of this video segment:
Steve: Just like every other profession, you’ve got the good, the bad and the ugly. To get it away from that subject, let’s talk about why you’re here. Are you presenting?
Dr. Taub: Yes, I did a presentation this morning on the use of a new category of drugs called PCSK9 inhibitors, which are used to treat elevated cholesterol.
Steve: Tell us a little bit about these drugs. It’s not a drug that you would give to 90% of your patients with diabetes with high cholesterol when there’s a generic drug out there that only costs cents per day. These new drugs are very expensive.
Dr. Taub: Yes, they’re very expensive and the FDA has only approved them for certain types of individuals. One of them are people that have familial heterozygous hypercholesterolemia. These are patients that have a genetic condition in which their LDL or bad cholesterol is really high, usually over 190. These patients often have a strong family history. That’s one category. The other category are patients who’ve had prior heart attacks, prior strokes, prior TIA, or have peripheral vascular disease, who need additional LDL lowering on top of the statin that they’re already on. That encompasses a lot of people with diabetes, because people with diabetes often have had a heart attack, a stroke, a TIA, and peripheral vascular disease as well. So very common in diabetics. So by that FDA indication, there are people with diabetes that are eligible for these drugs.
Steve: So, how low can the cholesterol be, or how high does it have to be, before they’ll even consider payment?
Dr. Taub: If a person falls into that category of having prior heart attack, prior stroke, and their LDL is over 100, technically, the insurance company should approve it based on the FDA indication. When they first came out last year, it was very difficult to get the drugs approved, but now it’s getting easier and easier. Most of the time I’m able to get the drugs approved if the patient has the appropriate indication.
Steve: How low have you seen this particular drug drop the LDL, from what to what?
Dr. Taub: I’ve seen in some of my patients that have really high LDLs, starting with 220. I’ve seen it drop to 80. Other patients that we’ve started at 130, I’ve seen it drop to 40s to 50s.
To view other segments in this video series:
Part 1: A Cardiologist’s Perspective on Diabetes
Part 2: New Cholesterol Drugs PCSK9 Inhibitors
Part 3: PCSK9 Side Effects
Part 4: Working with Diabetes Patients
Part 5: Advice on Treatment Methods
Part 6: Starting on PCSK9s
Part 7: Recommending New Drugs
Part 8: Results of Using New Drugs