Ultimate Guide to PCSK9 Inhibitors for Cardiovascular Health

2024-03-27 11:48:45

[바이오키워드] PCSK9 inhibitor

Entered 2024.03.27 11:57 Entered 2024.03.27 11:57 Modified 2024.03.27 14:31 Views 35

[사진=게티이미지뱅크]For people at high risk of developing cardiovascular diseases such as myocardial infarction and stroke, managing LDL-C (low-density lipoprotein cholesterol) levels is extremely important. Academic experts have consistently expressed the opinion that ‘the lower the number, the better’ to prevent related diseases.

Currently, domestic and international dyslipidemia treatment guidelines set separate target LDL-C levels for patients with coronary artery disease who are at very high risk of cardiovascular disease. Here, it is recommended to lower the level to ‘less than 55 mg/dL’ and ‘more than 50% of baseline’, which continues to trend downward. This is because research results are accumulating that the lower the level of LDL-C, known as bad cholesterol, the lower the risk of recurrence of cardiovascular disease.

In this regard, it is important to select a more powerful treatment for patients who cannot reach the target LDL-C level even with the standard drug therapy ‘statin’ and ‘ezetimibe’ combined. PCSK9 inhibitors have recently received increasing attention based on their accumulated LDL-C lowering effects in clinical practice.

PCSK9 is a protein secreted by the liver and acts on the LDL receptor to break down LDL-C. PCSK9 inhibitors interfere with the interaction between PCSK9 and its receptor and inhibit the degradation of the receptor caused by PCSK9. As a result, the receptor increases and LDL-C removal is activated, effectively reducing the level of LDL-C in the blood.

PCSK9 inhibitors can be used in patients with coronary artery disease, including myocardial infarction, when it is difficult to manage LDL-C levels with existing drug treatment alone. It plays a role in reducing the occurrence of cardiovascular disease events when used in combination with other lipid-lowering drugs or as monotherapy.

Recently, academic circles are emphasizing three treatment strategies to prevent recurrence of cardiovascular disease: ‘rapidly’, ‘lowerly’, and ‘longerly’ lowering LDL-C levels. In fact, in patients who have experienced myocardial infarction, the prognosis is poor, with the risk of recurrence and death rapidly increasing if LDL-C is not properly managed after the primary attack.

When it first occurs, the mortality rate is around 20-30%, but when it recurs, the mortality rate rapidly increases to 68-85%. In particular, the first year after myocardial infarction is a time when the risk of recurrence is very high. Therefore, for patients who have experienced myocardial infarction, the key to treatment is to lower and maintain LDL-C as quickly as possible.

For example, ‘evolocumab’, a PCSK9 inhibitor, quickly lowers LDL-C levels and helps reach the target level. In the results of a sub-analysis conducted on patients who experienced myocardial infarction among participants in the major clinical trial FOURIER study, when evolocumab was administered concurrently to patients who experienced myocardial infarction within 1 year, 83.8% had LDL- The C goal (less than 55 mg/dL) was achieved.

This rapid and powerful LDL-C lowering effect contributes to lowering the risk of cardiovascular events. According to the FOURIER study, evolocumab improved the primary composite endpoint (hospitalization for unstable angina, coronary revascularization, myocardial infarction, stroke, and cardiovascular death, MACE+) compared to the placebo group. It reduced the risk of major cardiovascular events (myocardial infarction, stroke, and composite endpoint for cardiovascular death, MACE) by 15% and 20%.

PCSK9 inhibitors are evaluated as major drugs that lower the risk of cardiovascular disease in the field of dyslipidemia based on their powerful and rapid LDL-C lowering effect.