Proprotein Convertase Subtilism/Kexin 9 (PCSK9) Inhibitors: Adding to the Armamentarium of the Primary Care Physician

Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of morbidity and mortality worldwide, and its prevalence is expected to further increase in the next decade. It imparts a substantial burden on the healthcare system. Dyslipidemia, defined as low-density lipoprotein (LDL), total cholesterol, triglycerides, or lipoprotein levels more than 90th percentile, or an HDL level less than the 10th percentile, is significant risk factor for ASCVD and offers a therapeutic target to reduce the morbidity and mortality associated with ASCVD. While statins remain first-line therapy for the primary and secondary prevention of ASCVD, many patients may not be able to tolerate statins. Furthermore, in many patients, statin therapy alone may not be sufficient in decreasing LDL cholesterol levels. Within the past decade, several new classes of cholesterol lowering agents have been developed and studied as potential adjunctive therapy for patients who are unable to meet target LDL levels with traditional therapy alone. While many of these therapies (fibrates, bile acid sequestrants, and niacin) have demonstrated limited utility in dyslipidemia therapy, the newer proprotein convertase subtilisin/kexin 9 (PCSK9) inhibitors have proven to be some of the most potent lipid-lowering therapies available. Recent studies have demonstrated promise for these agents in the role of future management of dyslipidemia. In this review article, we aim to provide a review of recent literature of the PCSK9 inhibitors. These targets may provide additional benefit and alternative options in the treatment of dyslipidemia in the future.