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Published on: August 28, 2018
Hyperlipidemia: Management with Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) Inhibitors
Muhammed Shahreyar1, Salem A Salem1, Mannu Nayyar1
1From Division of Cardiology, Department of Medicine, University of Tennessee Health Sciences Center, Memphis, TN (MS, SAS, MN, NG, SKGK); Division of Nephrology, Department of Medicine, University of Tennessee Health Sciences Center, Memphis (LKG); Department of Physician Assistant Studies, University of Tennessee Health Sciences Center, Memphis (LKG); Regional One Health, Memphis (SKGK).
Insights
New proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors offer an alternative to statins for managing hyperlipidemia. These agents effectively lower low-density lipoprotein cholesterol, especially for statin-intolerant patients or those needing additional lipid reduction.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
Background:
- Coronary artery disease (CAD) is a leading cause of death in the U.S.
- Hyperlipidemia is a significant, modifiable risk factor for CAD.
- Statins are the primary pharmacologic treatment for hyperlipidemia due to their efficacy, safety, and cost-effectiveness.
Purpose of the Study:
- To review proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors as a novel class of lipid-lowering agents.
- To discuss the mechanism of action, indications, efficacy, safety, and limitations of PCSK9 inhibitors.
- To highlight their role in managing hyperlipidemia, particularly for statin-intolerant patients or those with refractory hypercholesterolemia.
Main Methods:
- Review of scientific literature and clinical trial data on PCSK9 inhibitors.
- Analysis of their biological activity and impact on serum lipid levels.
- Evaluation of safety profiles, cost-effectiveness, and clinical applications.
Main Results:
- PCSK9 inhibitors significantly decrease low-density lipoprotein cholesterol (LDL-C) levels.
- They provide an effective alternative for patients intolerant to statins.
- PCSK9 inhibitors serve as valuable add-on therapy for patients not achieving LDL-C goals with statins alone.
Conclusions:
- PCSK9 inhibitors represent a significant advancement in hyperlipidemia management.
- They offer a crucial therapeutic option for specific patient populations.
- Further research and real-world data will continue to define their long-term impact on cardiovascular outcomes.
Abstract:
Coronary artery disease is the leading cause of death in United States. Hyperlipidemia is an independent and potentially reversible risk factor for coronary artery disease. The 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors, collectively known as statins, have been the mainstay of pharmacologic therapy. Their availability, ease of administration, low cost, and strong evidence behind safety and efficacy makes them one of the most widely prescribed lipid-lowering agents. However, some patients may be intolerant to statins, and few others suffer from very high serum levels of cholesterol in which statin therapy alone or in combination with other cholesterol-lowering agents is insufficient in reducing serum lipid levels to achieve desired levels. In 2015, the Food and Drug Administration approved a new family of lipid-lowering agents, collectively known as proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors.PCSK9 inhibitors are biologically active molecules that decrease serum low-density lipoprotein cholesterol compared with statin therapy alone. They serve as an alternative to statins for patients who are intolerant to statin or as supplemental therapy in those patients for whom lower levels in serum low-density lipoprotein cholesterol are not achieved by statins alone. This article discusses PCSK9 inhibitors, their mechanism of action, indications, efficacy, safety, costs and limitations.
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