PCSK9 inhibitors for acute coronary syndrome: the era of early implementation

Abstract

Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, a new cholesterol-lowering strategy, can decrease low-density lipoprotein cholesterol (LDL-C) levels by inhibiting PCSK9 and reducing the degradation of LDL receptors; thus, they are impacting the management of dyslipidemia to the prevention of cardiovascular events. Recent guidelines recommend PCSK9 inhibitors for patients who fail to achieve target lipids after ezetimibe/statin therapy. As PCSK9 inhibitors have been demonstrated to significantly and safely reduce LDL-C, discussions have begun to explore its optimal timing in coronary artery disease, especially in subjects with acute coronary syndrome (ACS). Also, their additional benefits, such as anti-inflammatory effects, plaque regression effects, and cardiovascular event prevention, have become the focus of recent research. Several studies, including EPIC-STEMI, suggest the lipid-lowering effects of early PCSK9 inhibitors in ACS patients, while some studies such as PACMAN-AMI suggest that early PCSK9 inhibitors can decelerate plaque progression and reduce short-term risks of cardiovascular events. Thus, PCSK9 inhibitors are entering the era of early implementation. In this review, we are committed to summarizing the multidimensional benefits of early implementation of PCSK9 inhibitors in ACS.

2023: The year in cardiovascular disease - the year of new and prospective lipid lowering therapies. Can we render dyslipidemia a rare disease by 2024?

“…It was shown that the use of HIS with evolocumab, compared to HIS monotherapy, led to a reduction in serum LDL-C concentration after 8 weeks by 40.7%, which was related to the fact that 95.7% of patients were in at the therapeutic target (vs. 37.6% in HIS monotherapy) [ 42 ]. Recent evidence also demonstrated the benefits of early PCSK9 inhibitors in lipid reduction, plaque stabilization, and short-term or long-term cardiovascular event prevention [ 43 ].…”

PCSK9 inhibitor in acute ischemic stroke patient receiving mechanical thrombectomy: early outcomes and safety

“…These pleiotropic effects of PCSK9 inhibitors have also observed in small human studies ( 11 , 13 ), with follow-up studies using IVUS showing regression of atherosclerotic plaques ( 14 ). Based on these insights, several recent and ongoing studies have been employing PCSK9 inhibitors early in the treatment process and off-label for patients with acute myocardial infarction who are receiving percutaneous coronary intervention ( 15 , 16 ).…”