Aurora Comms Blog

The good, the bad and the unknown

Posted on 04. Sep, 2009 by Handbaglady in Communications, Health

Cholesterol-related news and advice continues to feature heavily in the UK media. The general public is fed a constant stream of media stories about exercise, lifestyle and ever changing advice about what they should or shouldn’t eat and drink. With cholesterol-lowering or more accurately low-density lipoprotein cholesterol (LDL-C) in particular, there has been a shift away from focusing just on ‘wonder’ products, such as statins, to a more balanced approach of tackling lifestyle changes, as well as then considering pharmacological intervention.

A couple of years ago, statins alone were kings. The statin market was, and indeed still is, saturated and the media environment also covered the products endlessly. Now it is time to take a three-dimensional view. The shift towards looking at managing abnormal lipid levels (dyslipidemia) in a more holistic way, including diet and exercise, is clearly apparent and perhaps partly influenced by big public health campaigns such as the Government’s Change4Life which aims to get children and their parents taking positive action to improve their eating habits and lifestyle.

The changing face of cholesterol

In addition, over the last couple of years, there has been a shift in how cholesterol itself is reported on. Cholesterol was viewed very much as ‘the enemy’ and the public grew increasingly aware that high cholesterol was ‘bad’. However, with the growth in popularity of the functional foods market in recent years, the public are now starting to understand that it is not just about lowering ‘bad’ (LDL) cholesterol but also raising ‘good’ (HDL) cholesterol.

Statin dominance diminishing?

Statins are well established as the primary LDL-lowering intervention. It is however predicted that the global statin market will fall between 2007 and 2012, from 67% to 44% of the current sales volume. Most of this decline will occur when the world’s top selling medicine atorvastatin comes off patent in 2010. Generic statins are currently worth less than 20% of the audited statin market but their share will certainly increase. However, this does not mean that the dyslipidemia market will decline. On the contrary, growth in the market will come from non-statin segments such as niacin (nicotinic acid), fibrates and prescription omega-3. In addition, new drug types such as CETP inhibitors, Lp-PLA2 inhibitors and HDL mimetics are also in development. This wider choice of medicines and treatment options is good news for patients and for addressing existing unmet needs in this area.

Preparing for the future

The emergence of, and focus on, non-statin products will mean there are a lot of opportunities and indeed much work to do from a communications standpoint. New products mean new messaging and often education of healthcare professionals (HCPs) and the general public alike. It is clear that statins are well respected by HCPs and accepted by the public. Successful education and communications have taken place enabling people to understand the importance of lowering their LDL-C and the role in which statins play with this. However, the new non-statin products provide new communications challenges.

The next stage of education has already begun in getting people to appreciate the differences between LDL-C and HDL-C. In reality, many HCPs need convincing about the benefits of raising HDL-C levels – ongoing clinical studies are designed to provide them with the necessary evidence. There will clearly need to be effective communication about these results when they are published. If benefits are proven, it may change many HCPs views and the way they prescribe. Niacin is currently the most effective drug for raising HDL-C and also produces some additional degree of LDL-lowering when used with statins, but side effects do occur.

Of the new products still in the pipeline, CETP inhibitors appear to have the most potential for raising HDL-C. But for the time being niacin remains the most potent HDL-C raising product and there has recently been renewed interest in more tolerable niacin formulations and combination therapies with statins.

The good, the bad and the unknown

The third lipid parameter, which is certainly less well known by the general public are triglycerides, (fat in the blood). Very much a case of the good, the bad and the ‘unknown’. Fibrates are the first choice for lowering triglycerides (TG). However, if you ask the average person on the street about triglycerides, very few indeed will have a clue what they are and how they fit with cholesterol. There clearly needs to be more focus on communicating the whole lipid triad and the importance of all three parameters to manage cholesterol effectively.

In terms of communicating globally about this lipid triad, Aurora wouldn’t necessarily advocate undertaking a ‘know your numbers’ based approach or campaign because targets are different across the world. For example, in Japan the HDL-C and TG goals are the same as those in Europe, however the LDL-C target is far less aggressive than both the US and European guidelines at <140mg/dL (3.5 mmol/L). It makes sense to take more of a three-dimensional view based around the lipid triad and a holistic lifestyle approach.

In the UK, current treatment guidelines currently focus primarily on treating elevated LDL-C and secondly on treating reduced HDL-C and elevated triglycerides. Increasing attention is being paid to aggressive LDL-C management in high risk patients.

However, despite the guidelines, treatment which focuses simply on LDL-C fails to prevent most cardiovascular events so there is clearly an unmet clinical need. More crucially there is a need to educate HCPs about alternatives to statins and the importance of looking at all three lipid parameters. If evidence is published about the benefits of raising HDL-C, existing guidelines will clearly need to be revisited.

There is very much a general feeling of ‘job done’ in the medical community when it comes to the management of dyslipidemia. Complacency is maybe too strong a word but there certainly needs to be a re-generation of communication to HCPs, ensuring that they understand that the job is by no means done and dusted.

Clearly, good, long-term communications efforts have meant that HCPs and the public know all about statins and their associated benefits. It now remains for the same communication efforts and level of understanding to be achieved for the non-statin products that are emerging from the shadows of the statin giants.

Tags: CV health