New oral drug to hit ‘silent killer’ of bad cholesterol

Cardiologist Stephen Nicholls has designed a new treatment that lowers cholesterol levels by 65 per cent in patients who previously had no possible medical treatment.

Monash University Victorian Heart Institute director Stephen Nicholls.

Trials of the world’s first oral drug for a previously untreatable form of cholesterol have been hailed as a “game-changer” in treatment of the condition.

Muvalaplin is used to disrupt the body’s production of Lipoprotein (a), or Lp (a), a more dangerous cholesterol that ­affects 20 per cent of people worldwide.

Muvalaplin effectively lowered Lp (a) levels by up to 65 per cent in participants after two weeks, indicating far healthier circulation.

The research was led by Stephen Nicholls, director of the Monash University Victorian Heart Institute, in collaboration with the non-profit Cleveland Clinic and pharmaceutical company Eli Lilly. The results were published in the Journal of the American Medical Association.

Dr Nicholls is president of the Cardiac Society of Australia and New Zealand and program ­director of the Victorian Heart Hospital.

Another cholesterol, low-density lipoprotein (LDL), often dominates discussion around heart disease, but is far less of a threat than Lp (a). LDL can commonly be treated with statin drugs that limit the liver’s production of cholesterol and improve its ability to remove them from the blood vessels, but these have been ineffective on Lp (a).

“Lp (a) is essentially a silent killer with no available treatment; this drug changes that,” Dr Nicholls said.

“This drug is a game-changer in more ways than one. Not only do we have an option for lowering an elusive form of cholesterol, but being able to deliver it in an oral tablet means it will be more accessible for patients.”

The Australian Bureau of Statistics is carrying out a new study on high cholesterol during 2023-24, but the most recent report, in 2017-18, found that 1.5 million Australians, or 6.1 per cent of the population, had high cholesterol.

This rose to 21 per cent for those aged 65 and over.

As treatment has become more widely available and effective, deaths from heart disease dropped by 82 per cent between 1968 and 2018.

Muvalaplin will likely be a chronic therapy, meaning those diagnosed will take the medication permanently, prompting Dr Nicholls to make the treatment as approachable as possible for patients.

“We’re asking our patients to take these medications for the rest of their lives, so that has to be a shared decision made between the patient and their doctor,” he said.

“We opened the (Victorian Heart Hospital) and it filled pretty quickly; that tells me that we need better therapies, because we’re not preventing enough heart disease in the first place.”

Dr Nicholls said Lp (a) was “essentially cholesterol’s evil cousin”.

“What we’ve learned in the last 10 years is not only how Lp (a) plays a role in causing blockages in blood vessels, which causes heart attacks and strokes, but can actually play a role in narrowing the heart valves, which leads to heart failure,” he said.

Before any major distribution, Muvalaplin will need to pass another larger trial. If effective, it could be used in the treatment of other heart diseases.