Related Experiment Video
Updated: Oct 4, 2025
Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Barriers to prescribing proprotein convertase subtilisin-kexin type 9 inhibitors after coronary revascularisation
Jenny Nguy1,2, Sarah A Hitchen1,2, Nick S R Lan2,3,4
1Department of Pharmacy, Fiona Stanley Hospital, Perth, Western Australia, Australia.
Insights
Barriers to prescribing PCSK9 inhibitors in atherosclerotic cardiovascular disease (ASCVD) patients include low use of ezetimibe and insufficient lipid testing. These factors prevent patients from meeting criteria for subsidized therapy in Australia.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Guidelines recommend intensive lipid-lowering for atherosclerotic cardiovascular disease (ASCVD).
- Evolocumab, a PCSK9 inhibitor, became subsidized in Australia in May 2020 for ASCVD patients needing further LDL-C reduction.
Purpose of the Study:
- Identify barriers to prescribing PCSK9 inhibitors in hospitalized ASCVD patients.
Main Methods:
- Retrospective observational analysis of 331 patients undergoing PCI or CABG.
- Assessed lipid-lowering therapy prescriptions against Australian eligibility criteria.
- Identified barriers to PCSK9 inhibitor use via electronic medical records.
Main Results:
- No patients met criteria for subsidized PCSK9 inhibitor therapy.
- Suboptimal lipid testing rates (67.8-82.8%) and zero ezetimibe initiation for LDL-C ≥1.4 mmol/L.
- Most patients on high-intensity statins did not meet criteria due to lack of qualifying lipid levels post-combination therapy.
Conclusions:
- Non-statin LDL-C lowering therapy use is low in ASCVD patients.
- Underprescribing ezetimibe and suboptimal lipid testing are key barriers to subsidized PCSK9 inhibitor access.
- Current Australian eligibility criteria may hinder optimal lipid management in ASCVD.
Background:
Guidelines advocate for intensive lipid-lowering in patients with atherosclerotic cardiovascular disease (ASCVD). In May 2020, evolocumab, a proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitor, became government subsidised in Australia for patients with ASCVD requiring further low-density lipoprotein cholesterol (LDL-C) lowering.
Aim:
To identify barriers to prescribing PCSK9 inhibitors in hospitalised patients with ASCVD.
Methods:
A retrospective 3-month, single-site, observational analysis was conducted in consecutive patients undergoing percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery. Lipid-lowering therapy prescriptions, including PSCK9 inhibitors, were assessed using electronic medical records, compared against the Australian Pharmaceutical Benefits eligibility criteria, and barriers to PCSK9 inhibitor use identified.
Results:
Of 331 patients, 244 (73.7%) underwent PCI and 87 (26.3%) underwent CABG surgery. A lipid profile during or within 8 weeks of admission was measured for 202 (82.8%) patients undergoing PCI and 59 (67.8%) undergoing CABG surgery. In patients taking high-intensity statins on admission (n = 109), LDL-C ≥1.4, ≥1.8 and >2.6mmol/L was seen in 64 (58.7%), 44 (40.4%) and 19 (17.4%) patients respectively. High-intensity statin prescribing at discharge was high (>80%); however, ezetimibe was initiated in zero patients with LDL-C ≥1.4 mmol/L. There was variable advice given by clinicians for LDL-C targets. No patients met the criteria for subsidised PSCK9 inhibitor therapy, largely due to lack of qualifying lipid levels following combined statin and ezetimibe therapy.
Conclusion:
Prescribing of non-statin LDL-C-lowering therapies remains low in patients with ASCVD. Underprescribing of ezetimibe and suboptimal lipid testing rates are barriers to accessing subsidised PCSK9i therapy using current Australian eligibility criteria.
More Related Videos
10:28Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
05:41Left Anterior Descending Coronary Artery Ligation for Ischemia-Reperfusion Research: Model Improvement via Technical Modifications and Quality Control
Published on: December 16, 2022
Related Concept Videos
01:27Coronary Artery Disease V: Interprofessional Care
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:20Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
01:27Peripheral Artery Disease III: Interprofessional Care
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
01:23Treatment for Pulmonary Arterial Hypertension: Prostacyclin Receptor Agonists
These agonists bind to the IPR receptor situated on the plasma membrane of the pulmonary artery smooth muscle cells. This binding triggers a cascade of reactions known as the GS-AC-cAMP-PKA pathway. This pathway results in the relaxation of smooth muscle...