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Ray Kausik Part 6, Good Versus Bad Cholesterol

In part 6 of this Exclusive Interview, Dr. Ray Kausik talks with Diabetes in Control Publisher Steve Freed during the ADA 2017 convention in San Diego, CA about the impact of treatments in an ongoing effort to lower cholesterol.

Ray Kausik, MB, ChB, MD, is Professor of Public Health in the Department of Public Health and Primary Care at Imperial College London as well as Honorary Consultant Cardiologist at the Imperial College NHS Trust.

Transcript of this video segment:

Freed: We know that cholesterol isn’t all bad. There’s some elements to it that help prepare our blood vessels, etc.. So the question comes up; how low is too low and how low have we gotten with these new drugs?

Kausik: I think what I would say to you is that cholesterol is bad, period. But what we tend to think about all the particles that cholesterol is carried in. So, I think what you were referring to is the cholesterol that’s carried in the HDL particles, and there’s a disconnect between the cholesterol and the particle function itself. We’ve had drugs where we’ve increased HDL cholesterol by 120/130 percent and we have seen no benefit. So that’s why I would say that actually cholesterol is bad, period. And what we haven’t worked out is how to improve the function of those particles, or even if those levels are a measure of something else that’s a real target. So, I would take out HDL cholesterol in the argument for now, but what we have seen is you can keep lowering LDL cholesterol, down to levels of 15/20 mgs per deciliter; levels that you’re born with. There was a trial called FOURIER that looked at these people and the relationship. There was no J-shaped curve, kept on going down and even at those low levels, you got benefit.  We’ve seen that with other ways of lowering LDL cholesterol, with Ezetimibe. We had a large number of patients with seven years’ worth of follow up with very low levels down, less than 30 mgs per deciliter and there’s no sign of harm. So, in life, if your LDL cholesterol is lower, however you’ve lowered it, your risk is going to be lower. There’s no such thing as normal because 50 is better than 70 but 30 is better than 50.

Freed: But we do know that for a person with diabetes, we have some cardiovascular risk, that we want it certainly below 70… Is that not normal?

Kausik: Oh absolutely. I think in a world where there was no cost as an issue and tolerability was an issue, you want your LDL as low as possible with treatments that you can tolerate. So, I agree that [for] a diabetic patient, long-term certainly 70; if you’ve got additional factors as you know one of the guidelines, the AACE guidelines, suggests 55. So, what we are seeing is that lower is better, particularly in those at highest risk.

To view other segments in this video series:

Part 1: PCSK9 Inhibitor Treatment For Diabetes

Part 2: PCSK9 Effect On HDL Goal Levels

Part 3: PCSK9 Effect On Lowering Cardiovascular Death

Part 4: PCSK9 And SGLT2 Combination Therapy

Part 5: PCSK9 Inhibitor Cost