The pathology service in Cwm Taf University Health Board has introduced an innovative treatment for people with hypercholesterolaemia (people with a high cholesterol and at risk of heart disease).

The service, which was introduced in August 2016, is helping patients with the greatest need for treatment.

The PCSK9 inhibitor service initiated by Dr David Cassidy, Consultant Chemical Pathologist at Prince Charles Hospital, Merthyr Tydfil is for patients for whom statins (drugs that are effective in reducing cholesterol in the blood and reduce the risk of cardiovascular disease) are not a suitable treatment, either because they haven’t worked or they are not tolerated by the patient.

Statins have and remain the most effective treatment for lowering cholesterol since the early 1980’s and are tolerated by most patients. However a proportion of patients are unable to tolerate this treatment due to significant side effects.

PCSK9-Inhibitor is a new type of cholesterol lowering drug, known as Proprotein Convertase Subtilisin Kexin type 9 Inhibitor, which is administered by injection. The drug helps the liver to lower cholesterol levels in the blood.

This type of drug is only used in specific patient groups for whom statins are not suitable:

  • Patients with Familial Hypercholesterolaemia (FH), a genetic disorder characterised by high cholesterol levels and early cardiovascular disease
  • Patients who have cardiovascular disease and are at further risk.

Patients attend the Cardiac Day Care Unit for their first four injections and during this time they are taught how to self-inject, their cholesterol is carefully monitored and they are given time to discuss any concerns they may have about their treatment. Once patients have built up their confidence to self-inject, they can manage their condition at home, with regular checks at the day care unit.

Dr Cassidy said: “The service has been introduced following the collaborative working from the outset with medical, pharmacy and nursing colleagues, and highlights how pathologists bring direct patient benefit, whilst demonstrating the benefits of cross-team working.

“I have recruited 28 patients onto this novel treatment and the patients are tolerating the treatment well with no significant adverse effects and with a good reduction in cholesterol levels.

“Most of the patients have been long term attendees in my clinic but patients are being referred to our clinic from other specialties.

“This new treatment has brought clear benefits to patients who are at high risk of heart disease.  It allows them to manage their condition, with careful monitoring, and to get on with their lives.

“I am very pleased to say that patient feedback has been positive.”

One of the patients receiving treatment is Malcolm Richards who was working as a telecommunications engineer when he had a heart attack in 2006 and was admitted to Morriston Hospital. He was diagnosed with coronary heart disease but because of other complications, including a diagnosis of diabetes, it was decided that it was too risky to operate.

Malcolm was closely monitored and began treatment with statins to help lower the level of cholesterol in his blood and reduce risk of another heart attack. After taking the medication for some time, Malcolm developed extreme muscle pain and he was unable to tolerate statins. Malcolm was referred for treatment with PCSK9-I.

Working with Dr Cassidy and his team, Malcolm now manages his treatment with injections at home and is regularly checked to ensure that his cholesterol stays low.

Malcolm said: I’ve found it fairly easy to get used to giving myself the injections. This treatment means I can enjoy life, spending time with my wife, daughters and grandchildren.”

Innovative treatment introduced for patients with high cholesterol
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