Securing the Benefits of Medical Innovation for Seniors: The Role of Prescription Drugs and Drug Coverage. High Cholesterol

07/01/2002

  • Approximately 25 percent of the adult population in the U.S. has elevated blood cholesterol levels. (NIH 2002)
  • A high blood cholesterol level is a major risk factor for heart disease and stroke.
  • Drug therapy can effectively lower blood cholesterol.

Cholesterol is a soft, waxy substance produced by the body and found in foods of animal origin. It is present in the blood stream and all body cells. Since cholesterol cannot dissolve in the blood, it is transported to and from the cells by two main lipoprotein carriers: LDL (low-density lipoprotein) and HDL (high-density lipoprotein). A high blood LDL-cholesterol is one of the major risk factors for coronary artery disease, which leads to heart attacks. In contrast, a high level of HDL-cholesterol tends to protect against heart disease. The higher one’s blood LDL-cholesterol level, the greater the risk for developing heart disease or having a heart attack.

Percentage of 65-74 Year-olds with High Serum Cholesterol

Percentage of 65-74 Year-olds with High Serum Cholesterol

Source: National Health and Nutrition Examination Survey

Treatment of high cholesterol

Since an elevated LDL-cholesterol significantly increases the risk of heart disease, treatment is directed at lowering blood levels. Statins represent a new category of LDL-cholesterol lowering drugs. There are currently five statin drugs on the market: lovastatin, pravastatin, simvastatin, fluvastatin, and atorvastatin. Research has demonstrated that the use of statins results in large reductions of total and LDL-cholesterol, which decreases heart attacks and heart disease deaths. (NIH 2002) Studies using statins have reported 20 to 60 percent lower LDL-cholesterol levels in patients taking these drugs. (American Heart Association 2002) Current research findings are pointing to other possible benefits of statins, indicating that they may be helpful in preventing and treating a variety of conditions, including cancer, strokes, Alzheimer’s, adult-onset diabetes, deep vein thrombosis, and organ rejection in transplantation. (Bellosta 2000)

Despite the wide use of statins to lower blood cholesterol in the United States, some countries limit access to this class of drugs. For example, Simvastatin (Zocor®) is a statin that is used to lower blood cholesterol. In Australia, reimbursement for Zocor® is restricted to patients who fail six weeks of dietary therapy. In New Zealand, only three of the five FDA-approved statins are covered by the government’s health plan. (PHARMAC 2002)

Drugs in the pipeline for high cholesterol

  • Drugs designed to interfere with intestinal reabsorption of cholesterol are being investigated. (NIH 2002, Leitersdorf 2002)
  • Drugs that inhibit the cholesteryl ester transfer protein (CETP inhibitors) are in development. These drugs would work synergistically with statins to lower blood cholesterol. (NIH 2002, de Grooth 2002)
  • Vaccines that prevent the conversion of HDL to LDL cholesterol are under study. (PhRMA 2002)

New pharmaceutical approaches to elevated blood cholesterol are in development. Research is underway on an investigational drug (a cholesterol absorption inhibitor) that may provide additional reductions in LDL cholesterol when taken along with some statins. (Leitersdorf 2002) In addition, PhRMA reports that there is an effort to develop a vaccine that will lower blood cholesterol by preventing the conversion of HDL-cholesterol to LDL-cholesterol. (PhRMA 2002)

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