Physicians' Academy for Cardiovascular Education

Large interpersonal variation in estimated benefit from PCSK9 inhibition in CAD patients

Estimated individual lifetime benefit from PCSK9 inhibition in statin-treated patients with coronary artery disease

Literature - Kaasenbrood L, Ray KK, Boekholdt SM, et al. - Heart 2018; published online ahead of print

Introduction and methods

Patients with coronary artery disease (CAD) are at high risk for recurrent CV events, particularly if they have high LDL-c levels, despite high-dose statin therapy [1].

The Further Cardiovascular Outcomes Research with PCSK9 Inhibition in Subjects with Elevated Risk (FOURIER) trial showed that the proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor evolocumab attenuate the LDL-c-induced residual CV risk. It is, however, not clear which patients should be treated with this effective but costly therapy [2,3].

This study evaluated the individual benefit of PCSK9 inhibition in patients with stable CAD on high-dose statin therapy. The individual benefit was estimated from a lifetime perspective and expressed in terms of gain in life expectancy free of (recurrent) stroke or MI, in patients originating from the Treating to New Targets (TNT) trial [4,5].

The measures of individual benefit from PCSK9 inhibition in addition to high dose statins was estimated based on:

Main results

Conclusion

The potential incremental benefit of PCSK9 inhibition varies a lot among patients with stable CAD on high-dose statin treatment, ranging from a few months to more than a year gain in life expectancy free of recurrent stroke or MI. Highest benefit is expected in younger patients with a high risk factor burden and high LDL-c levels. Individualized estimated treatment benefit may contribute to targeted treatment and shared decision making on whether or not initiating PCSK9 inhibition in statin-treated patients with stable CAD.

References

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