News, literature and expert perspectives on PCSK9 inhibition in lipid management
Lp(a) concentrations have to be decreased by approximately 100 mg/dL in order to achieve clinically meaningful reductions in the risk of CHD, as shown by Mendelian randomization analysis.
A prespecified analysis of the ODYSSEY OUTCOME trial showed a bigger treatment effect of alirocumab with no adverse effects on measures of glycemia or new onset diabetes in patients with diabetes compared to those with normoglycemia or pre-diabetes.
A subanalysis of the ORION-1 phase II trial showed that inclisiran reduced LDL-c in high CV risk patients, irrespective of presence of diabetes.
ADA 2018 Analysis of ODYSSEY OUTCOMES trial indicates people with diabetes and prior ACS benefit most from the combination of alirocumab and statins, compared to ACS survivors with prediabetes or with normal glucose levels
Prof. Frederick Raal describes the prevalence and phenotypic variability of FH. Novel therapies have changed FH from a lethal disorder to a manageable dyslipidaemia.
The European Commission (EC) has approved the use of evolocumab in patients with established atherosclerotic CVD (MI, stroke, PAD) to reduce CV risk.
Inhibition of hepatic PCSK9 synthesis with the small interfering RNA inclisiran led to significant reductions of non-HDL-c and apoB, and increases of HDL-c, which were sustained up to day 180.
New ORION-data shows inclisiran has a one-size-fits-all dosing regimen of 300 mg on day 1, day 90 and every six months thereafter, across a wide range of dyslipidemia patients, including HoFH.
A model assuming 100% adherence to maximal statin dose showed that only 10% of heFH patients with CHD would reach guideline-recommended LDL-c goal, and about half of those without CHD.
The potential incremental benefit of PCSK9 inhibition varies a lot among patients with stable CAD, with the greatest benefit observed in younger patients with highest risk factor burden and high LCL-c levels.
Patients with a history of MI who are closer to their most recent event, have had multiple prior MIs or have residual multi-vessel CAD, had higher CV risk reductions with evolocumab.
Atherogenic dyslipidemia increases CV risk in diabetes patients. Prof. Ray discusses the importance of dyslipidemia in these patients, the associated CV risk and new medical therapies to reduce this risk.