Patient Populations Included in PCSK9 Inhibition Trials and Final Thoughts


The MD Magazine Peer Exchange “Amassing the Clinical Evidence for Optimized Dyslipidemia Management: Vitamin D, Long-Term Statin Outcomes, and PCSK9 Inhibition” features expert insight and analysis of the latest information on managing hypertension and hyperlipidemia, and in-depth discussion on the use of PCSK9 inhibitors in practice.

This Peer Exchange is moderated by Peter Salgo, MD, professor of medicine and anesthesiology at Columbia University and an associate director of surgical intensive care at the New York-Presbyterian Hospital in New York City.

The panelists are:

  • Christie Ballantyne, MD, Co-director of the Lipid Metabolism and Atherosclerosis Clinic at The Methodist Hospital, Director of the Center for Cardiovascular Disease Prevention at the Methodist DeBakey Heart Center, and the Chief of Cardiology at Baylor College of Medicine
  • Keith C. Ferdinand, MD, Immediate Past Chair of the National Forum for Heart Disease and Stroke Prevention, and Professor of Clinical Medicine at the Heart and Vascular Institute at Tulane University School of Medicine
  • Jennifer G. Robinson, MD, MPH, Professor in the Departments of Epidemiology & Medicine and Director of the Prevention Intervention Center, Department of Epidemiology at the College of Public Health, University of Iowa
  • Karol E. Watson, MD, PhD, Professor of Medicine and Cardiology, Co-director of the UCLA Program in Preventive Cardiology, and Director of the UCLA Barbra Streisand Women’s Heart Health Program

One of the exciting things about PCSK9 inhibitors, said Robinson, is that it has been shown to be effective in patients with familial hypercholesterolemia, people with long family histories of premature deaths in their 30s and 40s, who represent a huge unmet medical need. Ballantyne pointed out that PCSK9 inhibition has even shown some benefit in patients with homozygous familial hypercholesterolemia, as well as in patients with cardiovascular disease, high LDL levels, or patients labeled as statin-intolerant. The panelists were cautiously optimistic about the class, but, as Robinson pointed out, the safety of maintaining very low cholesterol levels long-term in these patients still remains to be proven.

Ballantyne’s take-home messages for the program included a move toward treating the process of atherosclerosis now instead of just symptoms of coronary disease, as well as treating high-risk patients intensively. Ferdinand said it will hopefully be beneficial for patients to assess risk rather than just treating symptoms. Robinson said that physicians have to believe in statins to be able to convince patients to stay on them long-term for their full benefit. Finally, Watson said that statins are the mainstay of risk-reducing therapy, but that lifestyle must be the foundation of everything we do.

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