The cholesterol drug that outperforms statins: Patients on the medication are ‘27% less likely to suffer a heart attack’, landmark trial shows

A powerful cholesterol drug cuts the risk of heart attacks by a quarter, a landmark trial has found.

Patients treated with injectable drug Repatha were 27 per cent less likely to have a heart attack and 21 per cent less likely to have a stroke over two years than if they had been taking statins alone.

The remarkable results are rooted in the drug’s ability to cut levels of ‘bad’ LDL cholesterol, which furs the arteries and causes heart problems.

The trials showed that Repatha, which was taken alongside statins, reduced cholesterol levels by 60 per cent more than taking statins alone.

Experts said the findings were the most important since the first statins trials were published two decades ago.

The results suggest the ‘extremely potent’ drug, which has been available on the NHS for 10 months, could save thousands of British lives.

Excitement about the drug has been building over the last three years, with scientists predicting it had the power to ‘switch off’ heart disease.

But that excitement was based on early studies which merely showed the drug could reduce cholesterol and stop furring of the arteries – and more cautious doctors insisted they needed proof it actually prevents heart attacks and strokes.

The new trial of 27,500 patients, led by Harvard Medical School and Imperial College London, finally provides that evidence.

It shows that for every 74 people given the drug for two years alongside statins, one heart attack, stroke or death would be prevented.

If all 325,000 eligible people in the UK were to be treated, 2,200 potentially fatal heart emergencies would be avoided every year.

And if guidelines are changed on the back of the new results, thousands more could benefit.

Professor Peter Sever of Imperial College London, whose results were presented at the American College of Cardiology annual meeting in Washington DC, said: ‘This is one of the most important trials of cholesterol-lowering since the first statin trial, published 20 years ago.

‘Our results suggest this new, extremely potent class of drug can cut cholesterol dramatically, which could provide great benefit for a lot of people at risk of heart disease and stroke.’

The study, also published in the prestigious New England Journal of Medicine, involved testing Repatha on patients in 49 countries, 1,500 of them in Britain.

Patients either took statins alone, or took Repatha – also known as evolocumab – alongside their statins.

Those who took both drugs were less likely to suffer a heart attack or stroke than if they took statins alone, the researchers found.

The benefits increased over time, with patients who took the combined treatments roughly 19 per cent less likely to suffer a heart attack or stroke in their first year, and 33 per cent in the second.

These results were seen across all groups of patients, even in those who started with low levels of cholesterol.

And there were no additional side effects beyond those seen with statins alone.

Professor Sever said: ‘There are a lot of people already on optimal doses of statins who have levels of cholesterol that could be lowered further.

‘What this trial shows is that if you achieve these really low levels of cholesterol, you get the additional benefit, and you get that without any apparent adverse effects.’

Coronary heart disease, in which the major arteries become clogged, affects more than 2.3million people in Britain, and 69,000 die from heart attacks every year as a result.

Last May NHS watchdog NICE approved Repatha and a similar drug called Praluent on the basis of early trials.

The drugs are self-administered with an injection pen, and work by blocking PCSK9, a naturally-occurring protein that interferes with the liver’s ability to remove cholesterol from the blood.

The treatments were approved only for specific groups – those with a genetic condition which means they have dangerously high cholesterol, and people with heart disease who cannot cope with the side effects of statins.

Overall 325,000 in Britain are eligible, although only a few have yet been given the drugs.

But the new evidence is the first to show they actually save lives, and could mean many more become eligible in the future.

Price could provide a stumbling block however.

Repatha costs about £4,400 per patient per year, although the NHS has agreed an undisclosed discount on this price.

Statins are incredibly cheap in comparison, costing the NHS about £20 a year per patient.

Professor Naveed Sattar, an expert in metabolic medicine at the University of Glasgow, said: ‘Can we realistically afford to extend the guidelines to bring these drugs to more people?

‘These results, I think, will mean the guidelines are adjusted slightly, but unless the price comes down it won’t mean we give it to anyone by any means.’

But Dr Marc Sabatine of Harvard, who led the trial, said doctors should start to target cholesterol far more aggressively.

‘We now have definitive data that by adding evolocumab to a background of statin therapy, we can significantly improve cardiovascular outcomes and do so safely,’ he said.

‘We need to treat LDL cholesterol more aggressively, and now we have a new validated means to do so.’

Professor Sir Nilesh Samani, medical director at the British Heart Foundation, said the trial was a ‘significant advance,’ adding: ‘While statins have had a significant impact in reducing the risk of heart disease for millions of people, they are not tolerated by everyone and only reduce cholesterol by a certain amount.’

Sean Harper, executive vice president at Amgen, added: ‘This is a game changer for high-risk patients.’