Top Treatments for High Cholesterol

About a third of American adults have high LDL cholesterol -- that's the bad kind -- but less than half of adults with high LDL seek treatment, according to the Centers for Disease Control and Prevention.

I smell an investment opportunity.

There's just one problem: Generics abound
While there's an opportunity to increase the market for cholesterol drugs, it's likely going to come from generic drugs. Both Merck's Zocor and Pfizer's Lipitor are available as cheap generics.


Sure, the generic-drug companies could benefit from increasing demand, but the products are just a small portion of their overall revenue. Buying for their copycat versions of Zetia and Lipitor isn't exactly an investment thesis.

AstraZeneca's Crestor, which is in the same class as Zocor and Lipitor, is still under patent protection, but having to compete with generics is putting pressure on sales. Pfizer had the same issue with U.S. sales of Lipitor when generic versions of Zocor were introduced. Crestor will remain a megablockbuster for some time, but I wouldn't buy AstraZeneca for it.

That leaves Merck's Zetia, which works to lower cholesterol through a different mechanism. In fact, Zetia has been combined with Zocor to form Vytorin, and with Lipitor to create Liptruzet. The three pills have a good shot at substantial growth, but only after the readout of the Improve-It trial, which is testing Vytorin against Zocor to see if adding Zetia not only reduces cholesterol further but also decreases heart-related events such as heart attacks and strokes.

The trial is scheduled to finish up in September 2014. The Zetia franchise made up 9.6% of Merck's sales in the first quarter, so it could have major implications on Merck's stock price in either direction.

In the works
PCSK9 is the newest target that seemingly every company is going after.

Sanofi and Regeneron Pharmaceuticals have one that's codenamed REGN727/SAR236553. In a phase 2 trial, it reduced bad LDL cholesterol by up to 67.9% compared with a 10.7% reduction in patients receiving placebo.

Amgen's PCSK9 inhibitor called AMG 145 seems to have comparable efficacy, reducing bad cholesterol by up to 66% in patients already taking a statin.

Pfizer, Roche, and Alnylam Pharmaceuticals also have drugs targeting PCSK9.

There's obviously lots of competition, and the data are a little too early to pick a winner yet. We'll have to wait for a phase 3 data to figure out which drug works the best.

Just as importantly, we'll need to see which drug is the safest. The companies will initially test the drugs in patients with dangerously high cholesterol levels, but the huge sales will obviously come from the larger population whose cholesterol levels are only slightly elevated. Since that population isn't as sick, safety will be a higher priority. A drug that has fewer side effects might top the sales charts even if it isn't the most efficacious.

This titan of the pharmaceutical industry stumbled into 2013 and continues to battle patent expirations and pipeline problems. Is Merck still a solid dividend play, or should investors be looking elsewhere? In a new premium research report on Merck, The Fool tackles all of the company's moving parts, its major market opportunities, and reasons to both buy and sell. To find out more click here to claim your copy today.

The article Top Treatments for High Cholesterol originally appeared on Fool.com.

Fool contributor Brian Orelli has no position in any stocks mentioned. The Motley Fool has no position in any of the stocks mentioned. Try any of our Foolish newsletter services free for 30 days. We Fools may not all hold the same opinions, but we all believe that considering a diverse range of insights makes us better investors. The Motley Fool has a disclosure policy.

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Charles Weber

Aneurysms, herniated discs, hemorrhoids, high cholesterol, and emphysema are among the most destructive, painful, and numerous diseases in our society. Slipped or herniated discs are estimated to cost 200 billion dollars directly and indirectly each year in the USA alone [http://www.futuremedicine.com/doi/pdf/10.2217/14750708.4.1.51 ]. Four to six of 100 Americans autopsied died of a ruptured aneurysm. 3.6 to 6 percent of those examined had non ruptured brain aneurysms [Renkel]. Each year, 16,000 Americans die due to a ruptured aortic aneurysm. Of the 200,000 strokes that occur each year in the USA, 20% are aneurysms in the brain. I suspect that copper deficiency status is the most important parameter affecting them. For instance, aneurysms are produced in turkeys by depleting copper [Guenther]. Copper deficiency causes blood vessels to become weak and is probably the chief cause of hemorrhoids and varicose veins. Restoring copper during those diseases is imperative.
Therefore increasing copper intake should have a dramatic effect on our collective health. Copper should always be made adequate even when an operation is in order.
That copper is below optimum in a large number of people is virtually certain from current evidence. Polish people are said to average 30% below the RDR (recommended daily requirement) from food [Pietruska] and 70% of Japanese are below the MDR (minimum daily requirement) [Otsuki]. Keep in mind that the MDR is designated too low to start with, as is the RDR. Young adult American women average 1.16 mg per day [Murphy] and men about 1.5. The difference between the sexes is no doubt primarily due to women eating less food than men. People in Belgium average 1.5 +/- 0.4 mg per day [http://www.springerlink.com/content/m552011168630u37/ ]. Adolescent males, both incarcerated and free, are below the RDA [Gans] which has been set at 2.0 but should be at least 3.0. Porto Rican school lunches are below the federal RDR [Preston]. Hemodialysis patients have low copper and zinc serum levels [Komindr]. Even so, a full blown copper deficiency takes several months to develop in people with an injured digestive system, much longer than for zinc [http://www.nphp.gov.au/enhealth/council/pubs/pdf/copper.pdf (p68)]. This is because the liver stores large amounts of copper. People vary considerably in their genetic makeup, and there are several dozen enzymes and hormones containing or affecting copper, so it should not be surprising that the symptoms of the diseases above should vary greatly or that "spontaneous" remissions are possible. When you further consider that other nutrients and circumstances also vary enormously, at least for those eating processed food, it is not safe to assume that copper is not deficient because all the symptoms are not present. Any symptom should trigger consideration of increased intake from some source. Emphysema [Soskel], premature gray hair [Wu], blood clotting [Milne 1896], slow

November 09 2013 at 11:40 PM Report abuse rate up rate down Reply