By Riya Ranjan
Cardiovascular disease — the number one cause of death in not only the U.S. but the world. Every year, more than 400 million people are diagnosed with some form of heart disease that jeopardizes the rest of their lives — instead of trips around the world, games of street basketball and family hikes, patients get frequent doses of statin (a drug that lowers cholesterol levels), wires and devices sewn into their bodies and a lifetime of doctor’s visits and medical bills. Until recently, this life has been the only way that cardiac patients can live. But now, scientists have developed new PCSK9 inhibitors that are set to revolutionize cardiac treatment.
A Closer Look
The way these inhibitors work is straightforward. Liver cells have receptors that destroy excess cholesterol (LDL), and in many cardiac patients, a protein called PCSK9 destroys these receptors. PCSK9 inhibitors stop this protein from attacking the cells and allow the body to naturally destroy excess cholesterol.
These inhibitors were first seen after they were published in a Harvard Health report by Dr. Gregory Curfman, an assistant professor of medicine at Harvard University.
“We’ve never before had medications that can reduce LDL cholesterol levels this much,” Curfman wrote. “As a cardiologist who has seen many people have their lives cut short by cardiovascular disease or who survived but with a poorer quality of life, I have my fingers crossed that a new class of cholesterol-lowering drugs may someday reduce the burden of heart and blood vessel disease.”
Based on the medicines that doctors administer today, such as simvastatin, atorvastatin, and lovastatin, heart patients often must undergo rigorous treatment and invasive procedures in order to allow their body to function properly, which is why drugs like PCSK9 have the potential to be so life changing. Junior Antara Goel was recently diagnosed with aortic stenosis, a condition that makes it hard for her heart to pump blood due to how narrow her aortic valve is. While Goel’s condition isn’t caused by increased cholesterol levels, as a cardiac patient, she experiences similar symptoms to patients with heart disease.
“The valves are a little bit closed so my heart has to work harder to pump blood,” Goel said. “So basically, I pass out if I do exercise, or if I do anything strenuous. It’s really hard for me to do a lot of things. But, I get by.”
Goel’s condition also requires her to frequently see a doctor to get an echo for her heart, something that almost every heart patient has to do in order to stay healthy.
Pictured here is a three-dimensional echocardiogram (ECHO) of a heart. Similar to an ultrasound, ECHOs look at the inner workings of the human body, helping model heart defects in cardiac patients.
(Wikimedia Commons, Kjetal Lennes)
Goel’s experiences as a patient have also given her insight on how serious diseases impact not only the patient but the family of the patient as well.
“I feel like for parents who do have to see their child go through that kind of pain as a patient — I can’t even imagine what kind of heartbreak they go through,” Goel said. “I struggle with depression, and my parents constantly say, ‘It’s so heartbreaking to see you in pain all the time.’ So, seeing [your child] in physical pain would just be like you can’t do anything about it — and as a parent, you feel like it’s your duty to take care of your child, and when you can’t do that, when that’s stripped away from you, that’s so — that’s so sad.”
The Monetary Battle
The emotional and physical struggle that cardiac patients have to deal with is something that can possibly be eliminated with the PCSK9 inhibitors — they have proven to be more than 60 percent more effective than any other drug that attacks cholesterol in cardiac patients, presenting a feasible way to eliminate symptoms in many patients. However, according to a recent New York Times report, these inhibitors have become almost impossible for patients to obtain. With prices that touch $15,000, insurance companies are turning many patients away and refusing to provide financial aid to most cardiac patients.
In an interview with the New York Times, heterozygous familial hypercholesterolemia patient Mackenzie Ames, who desperately needs the inhibitors to manage her condition, talks about her experiences with insurance companies surrounding the drug.
“I have followed every rule, and I still can’t get access,” Ames told the New York Times. “My doctor can’t get a straight answer.”
Although the inhibitors have sky-high prices, the effect that they can have on the lives of patients is priceless. These inhibitors can astronomically change the lives of patients like Ames, who is in constant need of dialysis, and in many cases, can save lives as well.
Goel, who has to deal with taking special medications herself, gives her perspective on the way insurance companies treat these patients.
“Imagine fighting a doctor and saying I really really need this medication and finally the doctor gives you permission saying that, yeah, I think you need it,” Goel said. “And then the insurance company turns you away — you’ve gone so far, and then the insurance company, the one company that’s supposed to be there for you, turns you away. In this scenario, the patient’s cholesterol levels could get too high and they could potentially pass away because of that. I think insurance companies just need to try and empathize and see what these people are struggling with.”
The PCSK9 inhibitors have the potential to be revolutionary in terms of cardiac treatment — if insurance companies will help declining cardiac patients get them. With these inhibitors, 31 percent of deaths worldwide, which are caused by some form of cardiac disease, can potentially be prevented. Millions of people will have the opportunity to once again travel around the world, play basketball with their friends and go on hikes with their families. The lives of cardiac patients everywhere could change for good — and it is all in the hands of this one, revolutionary drug.