Dr. PC Manoria: PCSK9 And Ezetimibe: Non-statin Agents For Dyslipidemia
Dyslipidemia accounts for 50% of coronary heart disease
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Dr. PC Manoria
Cardiologist and Physician
Manoria Heart and Critical Care Hospital, Bhopal
Studies have shown that the prevalence of dyslipidemia is very high in patients
presenting at coronary heart disease (CHD). According to Dr. PC Manoria, an eminent
cardiologist from Bhopal, it is 60-70%.
“The Indian population is characteristic of high incidence of diabetes, high triglyceride,
low HDL and elevated LP. High cholesterol and LDL is a problem, but not as much as it is
in the West,” he says in an interview with Dr. Manish Verma.
“LDL level as high as 190, xanthomas, premature arcus senilis in the eyes, premature
coronary artery disease or a history in the family are pointers towards familial
dyslipidemia, in which, even high dose statins cannot bring down LDL.”
“Among the non-statin lipid-lowering agents, ezetimibe has shown benefit in trials”
“Diet only constitutes 20% of the total cholesterol, 70% is manufactured in the liver.
Diet restrictions cannot dilapidate the plaque as well. So, statin use is mandatory in CHD
patients,” Dr. Manoria talks about diet for patients of dyslipidemia.”
Regarding the role of PCSK9 in pan-LDL control, he says, “Diet control can cut
cholesterol by 10-15%. Adding statins gives a further 50% reduction. PCSK9, in addition
to that, produces another 50% reduction.”
“Those who have high risk factors like obesity and are destined to become diabetic
develop it with the use of statins. But statins do not make a non-diabetic patient
diabetic,” he allays fears of diabetes developing due to use of statins.
“In primary prevention, a statin therapy of 5 years can be enjoyed for the next 20 years
but once you develop a heart disease, a life-long therapy is mandatory to prevent an