Conclusion
PCSK9 Inhibition for Use in Cardiovascular Disease Prevention
Although statins have revolutionised lipid therapy and secondary cardiovascular disease prevention, there remains a significant residual risk that can be further targeted. Certain populations may benefit from additive therapies: those with persistent elevation of LDL-C or residual risk despite optimal guideline-based therapy. Subjects with familial hypercholesterolaemia, for example, have been difficult to treat; despite maximum doses of lipid therapies, many subjects may not achieve sufficient reduction of LDL-C. Intolerance of statin, due to moderate to severe myalgias and/or a 5-fold increase in creatinine kinase have also limited the beneficial use of optimised lipid therapy, and this statin-induced myopathy may represent up to 10 % of treated patients in a primary care setting.62 At present, PCSK9 inhibitors have successfully shown to significantly reduce LDL-C, non-HDL-C and Lp(a) in different patient population and clinical settings. As we look to continued phase III clinical trials, particularly those measuring CV outcomes, PCSK9 inhibitors offer promise to patients with significant residual risk that treatment with PCSK9 inhibitors can further lower cardiovascular outcome events and related mortality.