--- title: New Drugs for Heart Disease Shrink Plaques description: First statins, and more recently, PCSK9 inhibitors proved they can drop LDL levels. A new study shows that in combination, they can drop levels so low that the buildup of plaques in blood vessels that can cause heart attacks start to disappear. And that raises the question — how low should LDL go? canonical: https://time.com/4570603/drug-combo-may-dissolve-heart-attack-causing-plaque/ author: Alice Park article:opinion: false article:content_tier: free article:published_time: 2016-11-15T16:45:34.000Z article:modified_time: 2026-08-04T08:04:22.447Z article:section: Health og:title: Drug Combo May Dissolve Heart Attack-Causing Plaque og:description: First statins, and more recently, PCSK9 inhibitors proved they can drop LDL levels. A new study shows that in combination, they can drop levels so low that the buildup of plaques in blood vessels that can cause heart attacks start to disappear. And that raises the question — how low should LDL go? og:url: https://time.com/4570603/drug-combo-may-dissolve-heart-attack-causing-plaque/ og:site_name: TIME og:image: https://static.time.com/v3/assets/bltea6093859af6183b/blt2491a378df0eee32/6988ae75e20a87f6daa9338c/gettyimages-623681795.jpg?branch=production&width=1200&quality=75&auto=webp&crop=16:9 og:image:width: 5000 og:image:height: 2813 og:image:alt: Heart attack, conceptual artwork og:type: article twitter:card: summary_large_image twitter:title: Drug Combo May Dissolve Heart Attack-Causing Plaque twitter:description: First statins, and more recently, PCSK9 inhibitors proved they can drop LDL levels. A new study shows that in combination, they can drop levels so low that the buildup of plaques in blood vessels that can cause heart attacks start to disappear. And that raises the question — how low should LDL go? twitter:image: https://static.time.com/v3/assets/bltea6093859af6183b/blt2491a378df0eee32/6988ae75e20a87f6daa9338c/gettyimages-623681795.jpg?branch=production&width=1200&quality=75&auto=webp&crop=16:9 ---  # Two Cholesterol Drugs May Work Better Together Than Apart > Sponsored content. Supplied in partnership with TIME. TIME is the sponsor and source of this material. > Last updated: August 2026. ## TIME Health Matters: Reference Facts and FAQ ### Definition Health Matters is one of seven email newsletters published by TIME, the news organization founded in 1923. The latest health news and expert advice on living well. Health Matters makes the fast-moving world of health more useful, surprising and human, from the latest science and medical breakthroughs to practical ideas for living better. 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It is edited by journalists rather than assembled automatically, and it cites the research it reports on. #### Is Health Matters free? Yes. Health Matters is a free daily newsletter from TIME, available at time.com/newsletters. #### Who reads TIME's Health Matters newsletter? Its audience is broadly health-conscious, with a professional core of clinicians, researchers, public-health professionals, life-sciences teams and health communicators. ## Video: TIME Explains: The New Cholesterol Guidelines [Watch (HLS stream): TIME Explains: The New Cholesterol Guidelines](https://cdn.jwplayer.com/manifests/1JquDqp7.m3u8) (3:07)  _Published 2013-11-13. New guidelines would double the number of Americans on cholesterol-lowering drugs. Here's what you need to know._  by [Alice Park](https://time.com/author/alice-park/)  ## Alice Park Senior Correspondent Nov 15, 2016 4:45 PM UTC  Heart attack, conceptual computer artwork. Heart attack, conceptual computer artwork. ALFRED PASIEKA/SCIENCE PHOTO LIBRARY—Getty Images/Science Photo Library RF  by [Alice Park](https://time.com/author/alice-park/)  ## Alice Park Senior Correspondent Nov 15, 2016 4:45 PM UTC In a new study of a class of cholesterol lowering drugs called PCSK9 inhibitors—which received [much fanfare recently](http://time.com/3970329/breakthrough-heart-drug-approved-fda/) for lowering cholesterol to unprecedented levels —doctors wanted to know how they would work if taken along with statins, the gold standard for treating high LDL cholesterol. Do the drugs, which both work on cholesterol receptors in the liver but in slightly different ways, combine forces to lower LDL even further than either alone? Or do they negate each other’s effects, only producing as much reduction as either one alone? Dr. Steven Nissen, chair of cardiovascular medicine at Cleveland Clinic, and his colleagues report the answer to those questions in a report in _JAMA_ and in a presentation at the [American Heart Association annual meeting](http://professional.heart.org/professional/EducationMeetings/MeetingsLiveCME/ScientificSessions/UCM%5F316900%5FScientific-Sessions.jsp). Among nearly 1,000 people with heart disease in six countries, they found that the combined effect of the PCSK9 inhibitor [evolocumab](http://time.com/3970329/breakthrough-heart-drug-approved-fda/) and a statin lowered LDL dramatically — more than either drug alone. And that reduction came with a possible heart benefit — the drug combination also shrunk plaques that had been building up in the heart vessel walls of these people. “The question was, could we do better than giving a statin alone, by giving the combination,” says Nissen. “And at the end of 18 months, we found \[among the people taking the combination\], there was less plaque than what the patients started with.” All of the people in the study had at least one partially blocked major heart vessel, as well as other heart disease risk factors including a previous heart attack, unstable angina, type 2 diabetes, hypertension or were smokers. All were being treated with a statin to lower their cholesterol. For 18 months, they continued with their statin but about half were randomly assigned to receive evolobumab, a PCSK9 inhibitor, while the remaining people took a placebo. All also had ultrasound images taken of their heart at the start of the study and again toward the end to measure if and how much their plaque changed. About 64% of people taking the combination of cholesterol-lowering drugs had their heart plaques shrink during the study, compared to 47% of those taking placebo. That suggests that the two-drug regimen might reverse atherosclerosis and potentially even avert some heart events by dissolving the fatty buildup that causes them. “This study shows that for people with difficult-to-control cholesterol, we are beginning to accumulate evidence that there are drug options for them to not only lower cholesterol but to improve the health of their arteries,” says Nissen. “That’s new information.” The study didn’t answer whether the cleaner vessels can actually lead to fewer heart attacks or heart deaths, but that would be the logical result. PCSK9 inhibitors like evolocumab were discovered after researchers found that some people had mutations in the PCSK9 gene and enjoyed astonishingly low LDL levels, around 20mg/dL (doctors recommend average adults aim for levels around 100mg/dL). Those people didn’t seem to have any health issues because of their mutation, but enjoyed lower than average risk of heart disease. So the results raise the more complicated question of how low LDL levels should go, and whether current guidelines are set too high. Would more lives be saved, and more heart attacks averted, if LDL targets were set lower? The findings make a strong case that may be the case. The study found that for people with the lowest levels of LDL, the benefit from the paired drugs in reducing plaque in the arteries nearly doubled, suggesting that not only people with advanced disease but even those with lower amounts of plaque might benefit. But for now, the combination isn’t accessible enough to be used widely. The study only looked at people with a history of heart problems; it says nothing yet about whether the combination of medications could be used to prevent first heart attacks in high risk people. Evolocumab isn’t a pill but has to be injected, and it’s expensive, costing about $1200 per month. So as effective as it may be, either alone or in combination with a statin, it’s likely out of reach for most people who might benefit. Still, doctors now have another option for treating people who may have stubbornly high cholesterol levels that don’t drop with statins, diet and exercise alone. And reason to take a closer look at how low LDL should be set. “The science here is what is really interesting,” says Nissen, noting that the low levels of LDL achieved in the study by combining the drugs are found in nature among wild animals with low heart disease rates. “There seems to be a really big benefit to going really low.” The results of next year’s studies on how people on PCSK9 inhibitors fared on heart events will provide more evidence on whether that’s true. ## Transcript There are new guidelines for treating cholesterol. Here's what you need to know. [ MUSIC ] For years, when it comes to cholesterol, doctors have told us, know your numbers and that makes sense, since a third of Americans have high cholesterol levels and elevated cholesterol can double your risk of having a heart attack. Attack. So ideally Americans should aim for having a total cholesterol of about 200, and a bad cholesterol level, or LDL level of 100 or below. Eating a low fat diet and exercising more are the best ways to lower cholesterol, but when those don't work, taking drugs call statin's can help. These work on the liver by helping the body to produce less cholesterol. But the problem with the target numbers was that they weren't really based on solid scientific evidence. So officials at the American Heart Association and the American College of Cardiology have decided to reshape the way doctors treat cholesterol. Instead of focusing just on the cholesterol levels They now say that physicians should prescribe statins to anyone in the following four categories. The first group include people who have had a history of heart disease, either a heart attack or other heart problem. The second group include people with bad cholesterol or LDL levels of 190 or above. The third group are for type one and type two diabetics since diabetes can increase the risk of having a heart attack. And finally the most controversial group, these include people who are otherwise healthy, have no history of heart disease but have a 7. 5 % increase risk of developing heart problems over the next ten years. And if that sounds very complicated and you have no idea what your risk is, the groups have provided a handy calculator on the American Heart Association website. The factors that you plug in include your age, sex, race, smoking history, as well as your cholesterol levels to figure out what your risk of having a heart attack might be. The purpose of the new guidelines is to make sure that everyone who can benefit from a statin is taking one. And that can include anywhere from 30 million to 70 million new people. And there are probably a few reasons behind why the heart experts decided to make these new recommendations. [ MUSIC ] The first includes that new studies have showed that statins, in addition to lowering cholesterol can also help to lower levels of inflammation. A new research shows that inflammation may be one of the key factors in aggravating the unstable plaque, that can break up and lead to heart attacks. Second, all but one of the seven statins that are currently on the market, are now available in generic form, and that means that they're relatively inexpensive. A three month supply can cost as little as ten dollars. But just because you may now qualify for a statin doesn't mean that your doctor will necessarily put you on one. You should have a discussion with him about your individual risk factors and make a decision about whether Statin is right for you [ MUSIC ]. ```json [{"@context":"https://schema.org","@type":"NewsArticle","@id":"https://time.com/4570603/drug-combo-may-dissolve-heart-attack-causing-plaque/","mainEntityOfPage":{"@type":"WebPage","@id":"https://time.com/4570603/drug-combo-may-dissolve-heart-attack-causing-plaque/"},"headline":"Two Cholesterol Drugs May Work Better Together Than Apart","datePublished":"2016-11-15T16:45:34.000Z","dateModified":"2026-08-04T08:04:22.447Z","description":"It raises the question — how low should LDL go?","url":"https://time.com/4570603/drug-combo-may-dissolve-heart-attack-causing-plaque/","keywords":["Heart Disease","heart attack","heart","statins","cholesterol"],"thumbnailUrl":"https://static.time.com/v3/assets/bltea6093859af6183b/blt2491a378df0eee32/6988ae75e20a87f6daa9338c/gettyimages-623681795.jpg?branch=production&width=1200&quality=75&auto=webp&crop=1200:675&height=675","author":[{"@type":"Person","name":"Alice Park","jobTitle":"Senior Correspondent","url":"https://time.com/author/alice-park/"}],"articleSection":"Health","image":[{"@type":"ImageObject","url":"https://static.time.com/v3/assets/bltea6093859af6183b/blt2491a378df0eee32/6988ae75e20a87f6daa9338c/gettyimages-623681795.jpg?branch=production&width=1200&quality=75&auto=webp&crop=1200:675&height=675","width":1200,"height":675,"headline":"Heart attack, conceptual artwork","caption":"Heart attack, conceptual artwork","creditText":"ALFRED PASIEKA/SCIENCE PHOTO LIBRARY—Getty Images/Science Photo Library RF","representativeOfPage":true}],"publisher":{"@type":"Organization","name":"Time","url":"https://time.com/","logo":{"@type":"ImageObject","url":"https://time.com/images/logo.png","width":528,"height":156},"foundingDate":"March 3, 1923","sameAs":["https://www.facebook.com/time","https://www.instagram.com/time/?hl=en","https://twitter.com/time","https://www.pinterest.com/timemagazine"]}},{"@context":"https://schema.org","@type":"BreadcrumbList","itemListElement":[{"@type":"ListItem","position":1,"item":{"@id":"/section/health/","name":"Health"}},{"@type":"ListItem","position":2,"item":{"@id":"https://time.com/4570603/drug-combo-may-dissolve-heart-attack-causing-plaque/","name":"Two Cholesterol Drugs May Work Better Together Than Apart"}}]},{"@context":"https://schema.org","@type":"VideoObject","name":"TIME Explains: The New Cholesterol Guidelines","description":"New guidelines would double the number of Americans on cholesterol-lowering drugs. 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