3 pills, ₹20 a day: SGPGIMS study finds cheaper way to control cholesterol

For heart patients, surviving a heart attack is only the first hurdle; the cost of preventing another can be a long-term financial burden. A study by Lucknow’s Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS) has found that a combination of three oral medicines costing around ₹20 a day helped nearly 85% of patients who underwent stenting bring their bad cholesterol below recommended levels within 48 weeks, offering a more affordable option for long-term cholesterol control.

The study, involving 322 patients, found that 84.8% achieved low-density lipoprotein (LDL), or bad cholesterol, levels below 70 mg/dL after 48 weeks of treatment. Another 69.6% brought their levels below 55 mg/dL. The findings were published in the Journal of Clinical Lipidology.

The research focused on patients whose cholesterol levels remained high despite conventional treatment following coronary stenting, a procedure used to open narrowed arteries and restore blood flow to the heart.

The combination comprised rosuvastatin (40 mg), ezetimibe (10 mg) and bempedoic acid (180 mg). Patients had been taking the first two medicines for at least 12 weeks but continued to have LDL levels above 70 mg/dL. Researchers added bempedoic acid as the third drug and assessed patients at 12, 24 and 48 weeks.

According to Dr Naveen Garg of the SGPGIMS cardiology department, average LDL levels fell from 82.1 mg/dL to 57.6 mg/dL within 12 weeks. The study also recorded a reduction in C-reactive protein (CRP), a marker of inflammation associated with cardiovascular risk.

Oral medicines cost less than injectables

The researchers said injectable cholesterol-lowering therapies, administered twice a month, can cost around ₹15,000 per injection, taking annual expenditure to approximately ₹3.5 lakh. In comparison, the three-drug oral regimen costs around ₹600 a month, or ₹7,200 annually.

However, the treatment was not without adverse effects. Uric acid levels increased in 21.5% of patients, while three patients discontinued treatment after developing gout, a form of arthritis.

The researchers said adding bempedoic acid may help patients who fail to meet cholesterol targets despite standard treatment. However, the study assessed cholesterol control over 48 weeks and did not establish whether the combination reduces repeat heart attacks or other cardiovascular events.

Cholesterol targets depend on risk

SGPGIMS cardiology department head Dr Aditya Kapoor said patients with established cardiovascular disease need stricter cholesterol control than the general population.

Patients who have undergone bypass surgery or suffered a heart attack followed by stenting should generally aim for LDL levels below 55 mg/dL. Those with two or more heart attacks may require a target below 30 mg/dL, depending on their clinical assessment.

People with diabetes, hypertension or a family history of premature heart disease should have their cholesterol targets determined according to their overall cardiovascular risk.

The study involved SGPGIMS cardiology department researchers, including Dr Amit, Dr Aditya Kapoor, Dr Satyendra Tiwari, Dr Rupali Khanna and Dr Ankit Sahu.