PCSK9 Inhibitors: An Effective Option for Cholesterol Treatment

Written by Bryan Heart cardiologist, Ryan Whitney, MD

Heart disease is a leading health problem in America. It affects over 92 million people and accounts for one of every four deaths each year. Aggressively treating cholesterol is a key component of managing cardiovascular disease and reducing the risk of future complications. A class of medications called the statins have been, and still are, the cornerstone of cholesterol lowering therapy. However, the PCSK9 inhibitors are a new class of medications approved to complement statin use in certain high risk individuals.

What Does a PCSK9 Inhibitor Do?

PCSK9 stands for Proprotein Convertase Subtilisin/Kexin type 9 and it plays a role in controlling the blood level of bad cholesterol, known as LDL. In liver cells, PCSK9 attaches to the LDL receptor. This results in reducing the number of LDL receptors available. The purpose of the LDL receptor is to grab LDL from the blood and remove it from circulation. If PCSK9 is blocked (inhibited), the number of LDL receptors goes up and the level of LDL in the blood goes down.

The FOURIER Trial

The purpose of the FOURIER Trial was to evaluate the ability of PCSK9 therapy to reduce complications of heart disease in high risk patients. The trial included over 27,000 patients diagnosed with cardiovascular disease. All patients were on statin therapy. The PCSK9 inhibitor used in the trial was Evolocumab (brand name Repatha). Trial participants were randomized to receive either a placebo or Evolocumab and were closely followed for an average of 26 months.  

Key results:

• Effective: 20% reduction in the combined outcome of heart attack, stroke and death from a cardiovascular cause
• Well tolerated: side effects were similar to placebo
• Consistent: compared to the placebo group, LDL decreased by 59% and stayed low throughout the trial
• Safety: even at very low LDL levels (30 mg/dL) there was no increase in adverse events

The FOURIER Trial demonstrated the use of Evolocumab in combination with statin therapy can further lower bad cholesterol levels and reduce the risk of future cardiovascular events.

PCSK9 Inhibitors Available through Bryan Heart

At Bryan Heart, we are proud to have participated in the FOURIER Trial. For more information on PCSK9 therapy or to refer a patient, call 402-483-3333.