Monoclonal antibodies for dyslipidemia in adults: a focus on vulnerable patients groups

ABSTRACT

Introduction

Dyslipidemia significantly contributes to atherosclerotic cardiovascular disease (ASCVD). Patients with lipid-rich vulnerable plaques are particularly susceptible to cardiovascular complications. Despite available lipid-lowering therapies (LLTs), challenges in effective lipid management remain.

Areas covered

This article reviews monoclonal antibody (mAb) therapy in dyslipidemia, particularly focusing on vulnerable plaques and patients. We have reviewed the definitions of vulnerable plaques and patients, outlined the efficacy of traditional LLTs, and discussed in-depth the mAbs targeting PCSK9. We extensively discuss the potential mechanisms, intracoronary imaging, and clinical evidence of PCSK9mAbs in vulnerable plaques and patients. A brief overview of promising mAbs targeting other targets such as ANGPTL3 is also provided.

Expert opinion

Research consistently supports the potential of mAb therapies in treating adult dyslipidemia, particularly in vulnerable patients. PCSK9mAbs are effective in regulating lipid parameters, such as LDL-C and Lp(a), and exhibit anti-inflammatory and anti-thrombotic properties. These antibodies also maintain endothelial and smooth muscle health, contributing to the stabilization of vulnerable plaques and reduction in adverse cardiovascular events. Future research aims to further understand PCSK9 and other targets like ANGPTL3, focusing on vulnerable groups. Overall, mAbs are emerging as a promising and superior approach in dyslipidemia management and cardiovascular disease prevention.

KEYWORDS:

• dyslipidemia
• monoclonal antibodies
• vulnerable patients
• PCSK9
• ANGPTL3
• cardiovascular disease
• LDL-C
• lipid-lowering therapy

Article highlights

• Dyslipidemia, a major contributor to atherosclerotic cardiovascular disease (ASCVD), is often inadequately treated.

• Monoclonal antibody drugs targeting PCSK9, including alirocumab and evolocumab, show promise in managing dyslipidemia and vulnerable plaques and preventing major adverse cardiovascular events in vulnerable patients.

• Monoclonal antibodies against other targets like ANGPTL3 offer a broader scope of ASCVD treatment possibilities.

• This review provides insights into the development, current status, and future prospects of monoclonal antibody.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosure

A reviewer on this manuscript has received honoraria for their review work. Peer reviewers on this manuscript have no other relevant financial or other relationships to disclose.

Additional information

Funding

This work was supported by CAMS Innovation Fund for Medical Sciences (CIFMS) (2021-I2M-1-008) and Major Program of National Natural Science Foundation of China (MP-NNSFC 82192902).