Are PCSK9 Inhibitors for you?
by Spencer Kroll MD PhD FNLA
The case for PCSK9 inhibitors is strong following the latest American College of Cardiology’s annual symposium and the National Lipid Association annual sessions. Most physicians remain uninformed about the clinical use of these medications in the treatment of existing cardiovascular disease and cardiovascular disease prevention.
Since PCSK9 inhibitors were introduced to the American market in 2015, study after study—most notably FOURIER in 2016 and this year’s ODYSSEY trial—has proven the efficacy of medications like evolocumab in lowering “bad” lipid levels in heart patients whose statin regimens alone aren’t getting the job done. The inhibitors have been shown to reduce coronary atheroma volume, improve atherosclerotic cardiovascular disease (ASCVD) in very high-risk patients and lower LDL-cholesterol in those with familial hypercholesterolemia (FH). Although access was limited thanks to high out-of-pockets costs, the pharmaceutical companies have recently slashed the prices of these important medications.
Regardless, strict approval guidelines still exist. Most physicians without expertise have trouble getting these medications approved. Dr. Kroll has extensive experience with these medications, both in terms of the research that led to their development, the initial implementation of them in therapy and now the prescribing of these medications for scores of patients. Dr. Kroll's office and The Cholesterol Treatment Center have extensive experience in gaining insurance company and Medicare approval for these drugs.
PCSK9 inhibitors have an excellent safety and tolerability record. They are effective reducers of atherosclerotic cardiovascular disease and they can also reduce the frequency of need for LDL apheresis in FH patients—but there’s also a lot clinicians don’t know.
It’s important to maximize statin intensity and statin adherence in patients before turning to PCSK9 inhibitors, especially since PCSK9 inhibitors and statins reportedly have therapeutically equivalent effects on the risk of cardiovascular events per unit change in LDL-cholesterol.