The effect of PCSK9 inhibitors on cardiovascular outcomes in diabetic patients: a narrative review

Cardiovascular events are a common occurrence in patients with diabetes mellitus. Multiple pharmacological interventions have been developed to reduce cardiovascular risk in this population; however, in this review, we focus on the role of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors in improving cardiovascular outcomes among diabetic patients. We provide an updated and comprehensive overview covering efficacy, safety, tolerability, and cost-effectiveness, while comparing these agents to the current standard of care, i.e., statins. Elevated low-density lipoprotein cholesterol (LDL-C) levels are strongly associated with adverse cardiovascular outcomes. By inhibiting LDL receptor degradation, PCSK9 inhibitors significantly enhance LDL-C clearance, leading to improved cardiovascular profiles. Evidence from large clinical trials such as FOURIER and ODYSSEY demonstrates consistent and promising reductions in major adverse cardiovascular events, even in diabetic subgroups. While the high cost and requirement for parenteral administration remain limitations, PCSK9 inhibitors represent a promising therapy for high-risk diabetic patients who fail to achieve lipid goals with conventional therapy and/or fail to adhere to the mainstay therapy due to adverse events.