Dr. Pam R. Taub talks with Diabetes in Control Publisher Steve Freed at the 2016 AACE Meeting. In part 8, the conclusion of this Exclusive Interview, Dr. Taub shares her findings after using new medications with her patients.
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: I want to thank you for your time. Before I let you go, because you’re going to be talking on these new cholesterol medications, what information would you like to get out to the family practitioners? A lot of doctors are afraid to write for these new medications, until they’ve been out 5, 10, 20 years sometimes. What would you like to tell them as far as using these new drugs for cholesterol, for LDL? By the way, have you seen any rise in HDL?
Dr. Taub: I have seen about a 5-12% rise in HDL. I would say that the data for these new drugs is very compelling. There’s two PCSK9 inhibitors on the market, alirocumab and evolocumab. Both of these drugs in clinical studies have shown up to a 50 to 60% lowering of LDL cholesterol. We don’t have the outcome studies yet. We’ll have them hopefully next year. What I would say is for people that really have high LDL cholesterol that we are not able to get to a level less than 100, these are people we should really consider, especially people that have had a prior heart attack or stroke. We should consider these drugs. The other group of people that are very under-appreciated are the familial heterozygous hypercholesterolemia patients. Anybody that’s walking around with an LDL over 190 untreated, which I would say 5-10% of many people’s practice, need to be on these drugs.
Steve: You mentioned that one of the side effects of the PCSK9 inhibitors is the site irritation. How does that compare to site irritation with insulin?
Dr. Taub: That’s an interesting question. I think the site irritation here is a little bit more pronounced because sometimes patients at the site of the injection are actually complaining of a cramping, significant pain. One of the things about the site reactions is sometimes patients are not administering the drug properly. You’re supposed to wait for 30 minutes, leave the drug out at room temperature before injecting, because when you don’t it’s viscous. Some of the sight reactions might be due to patients not doing it properly. That’s why we spend a lot of time educating them and having the nurse show them how to inject, so that could be it. But I don’t think it’s the same magnitude of what we see with insulin.
Steve: Can a patient do their self-injection?
Dr. Taub: Yes they can.
Steve: So they can be sent home with the medication for a month or whatever and this is done every two weeks.
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