Indications of PCSK9 Inhibitors for Patients at High and Very High Cardiovascular Risk

Effects of Loading-Dose Statins Combined with PCSK9 Inhibitor Pre-Treatment before Primary Percutaneous Coronary Intervention on the Short-Term Prognosis in Patients with ST-Segment Elevation Myocardial Infarction

“…PCSK9 inhibitors combined with statins further stabilize plaques, decrease distal thromboembolism and microvasospasm, and improve coronary blood flow and myocardial perfusion [20]. These effects are attributable to PCSK9 inhibitor-induced improvements in endothelial function, and anti-oxidant and anti-inflammatory activity, and a decrease in platelet activation and aggregation [21]. The PCSK9 inhibitors and statins were administered to patients within 1 hour after the beginning of the operation, and the interaction between drugs might have shortened the onset of pleiotropic effects, thus resulting in rapid onset of action.…”

O Desafio de Incorporar Tecnologias de Alto Custo: Uma Análise dos Inibidores de PCSK9

“…The authors used data from a cohort of patients treated at a public hospital in the Brazilian state of Bahia in combination with data from the FOURIER study, extrapolated for a period of 10 years, in a cardiovascular risk reduction model that simulates events in a Brazilian cohort. The population is the one most likely to benefit from the use of PCSK9 inhibitors in the context of non-familial dyslipidemia, 10 consisting of patients treated for acute coronary syndrome in the last year (57% with acute myocardial infarction) and LDL levels > 100 mg/dL, notwithstanding the use of atorvastatin and ezetimibe. The authors demonstrated an additional cost of 189,619 Brazilian reais (BRL) and an incremental cost-effectiveness ratio greater than 1 million BRL per cardiovascular outcome avoided.…”

Frontiers in Lipid Lowering Therapy: To Statins and Beyond

“…Typical LLT options comprise statins (more accurately, "vastatins"), which are effective in reducing all lipid profile fractions, including triglycerides (TGs) and low density lipoprotein-cholesterol (LDL-C), where attention is focused. 1,2 Statins represent a change from prior yet complementary LLT such as fibrates, 3 and gut absorption inhibitors like ezetimibe. 4 The benefits clearly seem to outweigh the disadvantages, 5 and the side effect profile (focused currently on statins) exaggerated in the press.…”

“…Others, like mipomersen (an antisense apolipoprotein B synthesis inhibitor), have been approved as statin alternatives. 13 The most recent alternatives include a LDL specific immunological approach via the serine protease proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, 1 which reduce LDL receptor loss, promoting LDL clearance, presenting an alternative for those at high CV risk with poorly controlled hyperlipidaemia either on statins or who are statin intolerant. Although expensive, LDL and CV adverse event reductions are impressive.…”

“…Although expensive, LDL and CV adverse event reductions are impressive. 1 Therefore, while LLT is established, on a planet with an increasing burden of ageing people and obesity, a correspondingly increasing prevalence of diabetes, and cardiac and vascular disease, the push through newer frontiers in the universe of LLT continues. What is not yet known is how these newer therapies will specifically impact on some specific vascular outcomes (e.g., for PAD), particularly when addressing fraction targeted therapies, and thus more specific research is now needed in this context.…”