High LDL cholesterol levels are a risk for the development of atherosclerosis. What are the clinical benefits of PCSK-9 inhibitors for cholesterol lowering?
At birth, LDL cholesterol concentrations are less than 50 mg/dl and then increase into adulthood. Values of 125 mg/dl are then not uncommon. However, very low LDL cholesterol levels reduce – according to current information – the risk of heart attack and stroke by one third. Possibilities to lower the levels exist by inhibiting HMG-CoA reductase using statins, cholesterol absorption using Ezetimibe or increasing LDL degradation using PCSK-9 inhibitors, as Prof. Franz, MD. R. Eberli, Zurich, pointed out. The latter have already proven their effectiveness in several studies. “PCSK-9 inhibitors lower LDL cholesterol by 60%,” the expert reported. They also score well in terms of safety: There were no indications of muscular or neurocognitive disorders. Antibodies are very rare and allergic reactions occur only occasionally.
But what about the clinical benefit of the new therapy regime? The major endpoint studies FOURIER and ODYSSEY mainly demonstrated a reduction in myocardial infarction rate (1.9% and 1.0%, respectively) and a reduction in cardiovascular events (2% and 1.6%, respectively). In contrast, the risk of cardiovascular mortality and all-cause mortality were not improved. “PCSK-9 inhibitors can be used in primary and secondary prevention to reduce cardiovascular events, within the limitation given by the FOPH,” Eberli concluded.
Source: Zurich Review Course in Clinical Cardiology.
CARDIOVASC 2019; 18(3): 38 (published 7/6/19, ahead of print).
