Dr. Campbell: New discovery may help prevent heart attacks - WNCN: News, Weather


Dr. Campbell: New discovery may help prevent heart attacks

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A new drug is in phase two clinical trials and is nearing approval. The drug creates a change in a gene responsible for the production of a particular protein that causes increased levels of triglycerides—a fat in the blood that has been associated with an increased risk for heart attack.

Cholesterol, as we know, is a major risk factor for the development of heart disease and subsequent heart attacks. Cholesterol is made up of many different types of particles--some of these particles are much more likely to contribute to the formation of blockages in the heart arteries.

There are two main types of cholesterol—LDL (low density lipoprotein) also called bad cholesterol and HDL (high density lipoprotein) or good cholesterol. Triglycerides are a type of fat associated with cholesterol and have been shown to increase risk for heart attack.

There is one type of particle in the body that is associated with lipid abnormalities and is called the ApoCIII protein. When levels of this protein are high, you are more likely produce high levels of triglycerides and ultimately produce plaques that can produce heart artery (coronary artery) blockages.

Two major studies by leading research groups published last week in The New England Journal of Medicine independently identified mutations in a single gene that protects against heart attacks by keeping levels of triglycerides — a kind of fat in the blood — very low for a lifetime. Now drug makers have a drug that targets this gene and can artificially create this mutation in those who take it---likely eliminating risk for high triglycerides and significantly reducing risk of heart attack over a lifetime

In this study, the researchers sequenced the genomes of a large number of people and then identified those with low triglyceride levels and a particular mutation of the ApoCIII gene associated with low triglyceride levels. They then subsequently evaluated their association with the risk of coronary heart disease in 110,970 persons identified. What they found was powerful. The risk for heart disease in the people who had the mutated gene were 40 percent less likely to develop heart disease.

A second study published in the same issue of the NEJM showed similar findings in a similar population genetic study (done independently).

Interestingly, this research was based on a small prior study in a population of Amish people who had a very low rate of heart disease and low triglycerides.

The Amish study had discovered that people with such a mutation could drink a big, rich milkshake, loaded with fat, and their triglyceride levels did not budge. For everyone else, they spiked. The new studies show what that means for people’s health. Now these new studies show that lower triglycerides significantly reduce your risk for heart attacks.

A small California company, ISIS, also hit upon the gene when it was looking for ways to make triglyceride levels plunge in the small group of people with disorders leading to triglyceride levels so high they could be fatal. They made a drug that counteracts the gene and began testing it. It slashed triglyceride levels by 71 percent.

The drug, ISIS-ApoCIIIRx, targets the production of ApoCIII and decreases triglyceride levels in at-risk patients. By working like a genetic mutation, these drugs actually prevent the formation of the ApoCIII protein by the body and can possibly lower triglyceride levels for a lifetime. In fact, the idea for the development of these drugs came from studying an Amish family with incredibly low triglycerides. They found that they had this particular mutation and the drug companies now have capitalized on this finding by making a drug that produces the same effect as the mutation.

In the past, statins have been very good at lowering other types of cholesterol and fats known as LDL and have been shown to prolong life in those with heart disease. Statins have been our only real choice in those with high cholesterol and triglycerides and now we may have another choice to add to those who do not respond as well to statins.

Heart attacks are the leading killer in the United States, and about 720,000 Americans a year have them. Although statins are effective in reducing heart attack risk, many users still have high levels of triglycerides and go on to have heart attacks. So the results of the new studies are good news.

Normal triglyceride levels are around 150---if we use this new drug on those with slightly elevated triglycerides (200 or more) we may be looking at treating over 20 percent of the population

As with most things, cost will be a real issue. Most new drugs are protected from generic alternatives for many years (and billions of dollars).

To get in touch with Dr. Campbell, you can head to his website, Facebook page or message him on Twitter.

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