Heart attack patients with diabetes may benefit from cholesterol-lowering injections

Heart Attack; Regular injections of a cholesterol-cutting drug could reduce the risk of heart attack or stroke in patients with diabetes and who have had a recent heart attack. The findings come from a trial of almost 19,000 patients with a recent heart attack or unstable angina and who were already taking the highest doses of cholesterol-lowering medication statins.

Researchers found that patients taking an additional twice monthly injection; of another type of cholesterol lowering drug, called alirocumab, further cut their cholesterol levels significantly; also reduce their risk of having another heart attack. The scientists behind the latest analysis led by researchers at Imperial College London say that alirocumab could provide more benefit to patients with diabetes, compare to those without diabetes, following a recent heart attack.

Heart attack patients

Alirocumab is a monoclonal antibody license for patients throughout the world. It is part of a class of cholesterol-lowering drugs called the PCSK9 inhibitors. The drug is deliver by injection every two weeks; also works by blocking the action of a key enzyme in the liver to reduce LDL cholesterol levels in the blood. Previous research has show that alirocumab is safe and effective at reducing LDL cholesterol levels, without increasing the risk of diabetes.

However, PCSK9 inhibitors are more expensive than other cholesterol-lowering drugs; so such as statins, and cost an estimated £4000 per patient per year in the UK; so their use is restrict to patients with the highest levels of LDL cholesterol. Doctors are therefore considering who would benefit most from this class of drugs.

Professor Kausik Ray, Chair in Public Health at Imperial College London; also first author of the study, explained: Cholesterol lowering injections, such as alirocumab, are effective but they are expensive; so they need to consider targeting them to where they will have the most impact. Diabetes patients make up about one third of all heart attacks; also these patients have roughly twice the risk as those without diabetes.

In this study, we found that alirocumab had greater reduction; so in risk for patients with diabetes compared to those without. People with diabetes who have recently had a heart attack and who have high LDL cholesterol, despite statins, are an easily identifiable and cost-effective group to think about giving these treatments to.

The cholesterol levels

The distribution of patients in the trial was similar to earlier studies; so with diabetes or prediabetes making up approximately 70 per cent of the cohort. Whether a patient had diabetes or not did not influence their LDL cholesterol levels; hence at the start of the trial, or during the treatment period (when they received either alirocumab or placebo).

After an average follow up period of 2.8 years, the team find; so that alirocumab was equally effective in reducing risk across the three groups but because people with diabetes were at highest risk they gain bigger absolute benefits. Analysis reveal that for diabetes patients, in absolute terms, treatment with alirocumab reduce their risk of further cardiovascular events by an average of 2.3 per cent.

While reducing blood cholesterol has proven benefits for cardiovascular health; so there has been some uncertainty regarding whether achieving very low levels of LDL cholesterol increases the risk of diabetes. The researchers say the current study; so amongst almost 19,000 patients including more than 5000 people with more than three years of follow up, shows there was no increased risk of diabetes with alirocumab.