Dr. Yvonne Smyth:

I thank the Deputy. The drugs we are referring to are something called PCSK9 inhibitors. When we talk about cholesterol circulating in the bloodstream, there essentially are two sources. One is our diet but that is only a small part of where the cholesterol comes from. Most of our cholesterol actually comes from what our liver makes and some of that is genetically predetermined. The Deputy will have heard of statins, I am sure. They are around since the mid-eighties and they have revolutionised cardiology in terms of reducing heart-attack risk and dying from a heart attack. However, some people cannot take statins for a variety of reasons and these drugs can be an alternative in that situation. However, here in Ireland, it is incredibly difficult to utilise them for that reason. If you have a patient who has had multiple stents to treat their coronary artery disease and their high cholesterol has been a major contributing factor, and they cannot take statin therapy for one reason or another and we would like them to avail of a PCSK9 inhibitor, when we go to fill in the paperwork for the medicines management programme, we will find that its definition of coronary artery disease is very restricted. It is somebody who has either has a heart attack or a bypass. If you have a 90% blockage in a critical location that has been stented, that does not meet the programme's definition of having coronary artery disease. As my colleagues, Professor McKeown in particular, has explained in terms of hereditary hypercholesterolemia, those drugs again are for that population. They particularly benefit from these drugs. Even though they are injectable agents, the drugs are only given once or twice a month. They are quite easy to take but they are expensive. The reason there is such restriction on them in our jurisdiction is because of the price, because they are so costly and because you will typically be prescribing them for life for these patients. Even though we feel some of our patients should be able to avail of them because they definitely have coronary artery disease and high cholesterol and they may or may not have a genetic condition, by and large we are unable to use them.