PCSK9 inhibitors: Ratification of the role of LDL cholesterol in cardiovascular prevention. Towards a convergence of European and North American prevention guidelines?

Abstract

The epidemiological association of cholesterol associated with low density lipoproteins (LDL-c) levels and the development of atherosclerotic vascular disease has been ratified by mendelian randomization studies. Paradoxically, the success of statins led to the underestimation of other lipid-lowering therapies and even the measurement of LDL-c. Recent studies show that the reduction of LDL-c to extraordinarily low levels through absorption inhibition, and, in a particularly intensive manner, with monoclonal antibodies against pro-protein convertase subtilisine Kesine 9 (PCSK9) continues to offer cardiovascular protection. However, the high cost and limited experience with PCSK-9 inhibitors advised a prudent use of them. An appropriate selection of patients most likely to benefit from treatment with PCSK9 inhibitors emerges as the basis for a consensus of international guidelines: the combination of a high absolute vascular risk and a greater expected benefit by the starting LDL-c levels.

Keywords: Aleatorización mendeliana; Análisis de coste-efectividad; Cholesterol; Clinical guidelines; Colesterol; Cost-effectiveness analysis; Ezetimiba; Ezetimibe; Guías clínicas; Hydroxymethylglutaryl-CoA reductase inhibitors; Inhibidores de proproteína convertasa subtilisina kexina 9; Inhibidores hidroximetilglutaril coenzima A reductasa; Lipoproteínas de baja densidad; Low densitiy lipoprotein; Mendelian randomization analysis; Numbers needed to treat; Número necesario a tratar; Prevención cardiovascular; Proprotein convertase subtilisin kexin 9 inhibitors.