PCSK9 inhibition in addition to background statin therapy: is there an added role?

Statins form the mainstay of treatment for secondary prevention of atherosclerotic cardiovascular disease. A proportion of patients however fail to reach target LDL-C levels despite statin therapy or are intolerant of therapy entirely. Add-on therapy with PCSK9 inhibitors has been shown to reduce LDL-C by up to 60% in statin treated patients. In this study the cardiovascular outcomes benefit of Alirocumab were assessed in relation to the intensity of background statin therapy including no statin treatment in patients hospitalised with ACS in the preceding 12 months.

The findings of this study show that the relative risk reductions from baseline in LDL-C were similar across all groups (high intensity, low/moderate intensity and no statin) approaching approximately 60%. Absolute reductions differed (-52.9, -56.7 and -86.1mg/dL respectively P<0.0001) with the greatest reduction seen in the no-statin subgroup consistent with differences in baseline LDL-C levels. Fewer patients achieved the guideline recommended LDL-C target in the no-statin subgroup compared to the statin treated subgroups. Alirocumab reduced MACE in each statin subgroup.

The study results show that Alirocumab reduced the relative risk of major adverse cardiovascular events regardless of the level of background statin therapy (including no-statin therapy). Even though the no-statin subgroup was small and the trial was not specifically designed to determine the efficacy of PCSK9 inhibition in statin-intolerant patients, the findings indicate that PCSK9 inhibitors could have a more prominent role in reducing the cardiovascular risk of patients unable to tolerate statins.

Note: The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology