If my high cholesterol doesn't run in my family, can I still get the injection? | Dr. Carlo

Question 1

If my high cholesterol doesn't run in my family, can I still get the injection?

Accepted Answer

Yes, there's also a shot for high cholesterol that isn't inherited. In the U.S., evolocumab is now approved for adults with uncontrolled LDL and high cardiovascular risk. The one-dose trial in the video is for familial hypercholesterolemia. Your doctor decides if it's right for you, based on your LDL and overall risk.

Question 2

Why does the liver make too much of the protein that destroys cholesterol receptors?

Accepted Answer

It isn't always that protein. In familial hypercholesterolemia, the LDL receptor usually fails. Sometimes it's APOB, LDL's docking protein. Rarely, it's excess PCSK9, the protein that breaks receptors down. Either way, the liver clears too little cholesterol and LDL rises. Blocking PCSK9 leaves more receptors working.

Question 3

If I already take a statin, can I add the injection, or do I have to stop the pills?

Accepted Answer

A statin and the shot can be used together, since they lower LDL in different ways. The shot is used mostly when a statin isn't enough or isn't tolerated. Stopping either on your own isn't wise, since LDL can climb back up. Ask your doctor what your LDL goal is and whether your statin should be adjusted.

Question 4

If my LDL is high but my triglycerides and HDL are normal, is it still a problem?

Accepted Answer

Yes, it still matters. LDL by itself causes the artery disease behind heart attacks and strokes. The risk grows with how high it is and how many years it stays high. Normal triglycerides and HDL are welcome news, but they don't erase that effect. Your doctor weighs your LDL with the rest of your risk.