Physicians' Academy for Cardiovascular Education

PCSK9 levels positively associated with outcomes in patients with worsening HF

The PCSK9-LDL Receptor Axis and Outcomes in Heart Failure BIOSTAT-CHF Subanalysis

Literature - Bayes-Genis A, Núñez J, Zannad F, et al. - J Am Coll Cardiol 2017;70:2128–36

Main results

Conclusion

In the BIOSTAT-CHF cohort, risk of death or hospitalization for HF was positively associated with circulating PCSK9 and negatively associated with LDLR in patients with WHF. Circulating PCSK9 levels may contribute to risk prediction in HF patients. These data suggest that PCSK9 inhibition might lead to better outcomes in HF.

Editorial comment

In his editorial article [5], Francis emphasizes that patients in the BIOSTAT-CHF cohort had WHF, as opposed to chronic stable HF, in which the prognostic role of the PCSK9-LDLR axis is unclear. Moreover, he suggests that two important questions should be investigated:

  • whether there is a cause and effect relationship between the PCSK9-LDLR axis and long-term outcomes
  • whether PCSK9 inhibition in patients with WHF will lead to improved outcomes

The current data add to our understanding of the interaction between lipid abnormalities and WHF, which has long received little attention. Brief treatment with novel HF therapy regimes has not resulted in reductions of important endpoints in clinical trials of patients with WHF; it is interesting to study whether PCSK9 plays a role in the worsening of HF and in the context of acute, decompensated HF.

The author concludes: ‘Last, there is the issue of the cost of PCSK9 inhibitors.’ (…) ‘Current restrictions on access to expensive drugs send a strong message to physicians and patients, as well as to innovators, that the benefits must be substantial if such drugs are going to be widely used. Nevertheless, these investigators have uncovered an interesting finding that may warrant further study, particularly if it can successfully be applied in a therapeutic manner to patients with acute, worsening heart failure.’

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