Emerging PCSK9 inhibitors for treating dyslipidaemia: buttressing the gaps in coronary prevention

Abstract

Introduction: Atherosclerotic cardiovascular disease (ACVD) is the leading cause of mortality worldwide. An abnormally high plasma level of low-density lipoprotein-cholesterol is a major contributor to ACVD, an effect that can be attenuated by cholesterol-lowering therapies, particularly statins. A new class of drugs, the proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, will add another option for further reducing cardiovascular events in patients at high risk of ACVD, including those with familial hypercholesterolaemia (FH) and intolerance to statins. Patients with elevated levels of lipoprotein(a) (Lp(a)) are difficult to treat with conventional therapies, and may also benefit from PCSK9 inhibitors.

Areas covered: This paper discusses the medical need for additional cholesterol-lowering therapies and the scientific rationale and current therapeutic status of PCSK9 inhibitors.

Expert opinion: The use of anti-PCSK9 mAbs is the leading form of therapy for inhibiting PCSK9 and is likely to provide genuine hope for patients with FH, statin intolerance and elevated Lp(a). Their ability to reduce cardiovascular events in patients maximally treated with statins and other existing therapies remains to be proven, and is the subject of major ongoing clinical trials.

Keywords:

• alirocumab
• bococizumab
• evolocumab
• familial hypercholesterolemia
• proprotein convertase subtilisin/kexin type 9 inhibitors
• statins

Declaration of interest

GF Watts has received honoraria for advisory boards and research grants from Sanofi and Amgen. The authors have no other relevant affiliations or financial involvement with any organisation or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

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