Coronary heart disease and chronic kidney disease: the possibilities of PCSK9 inhibitors in the achievement of atherogenic lipoproteins target values

Abstract

Objective: Possibilities evaluation of achieving the target values of atherogenic lipoproteins in patients with coronary heart disease (CHD) in combination with renal dysfunction during drug correction with PCSK9 inhibitors.Material and methods: The study included 76 men with CHD with very high cardiovascular risk divided into 2 groups: without chronic kidney disease (CKD) (n = 39) and with stage IIIA–IIIB CKD (n = 37). All patients did not reach the target values of lowdensity lipoprotein cholesterol (LDL cholesterol) after 8 weeks of the maximum dose of atorvastatin and ezetimibe, which was the motivation for the use of PCSK9‑alirocumab inhibitors, with control of the lipid profile and glomerular filtration rate for 6 months.Results: In the group of patients with CHD, 87.1% of patients (n = 34) reached the target values of LDL cholesterol, the level of LDL cholesterol decreased from 4.41 ± 0.19 mmol to 1.28 ± 0.14 mmol (p < 0.001), in the group of patients with CHD + CKD stage IIIA–IIIB 56.7% of patients reached the target values (n = 21), the LDL cholesterol level decreased from 4.6 ± 0.2 mmol to 1.37 ± 0.09 mmol (p < 0.001). There was no statistically significant change in the glomerular filtration rate during the study.Conclusion: The results of this study demonstrate the obvious effectiveness of PCSK9 inhibitors in achieving LDL cholesterol target values in patients with coronary heart disease with a very high cardiovascular risk. During the study, a decrease in the level of LDL cholesterol by more than 70% was noted. The absence of CKD in CHD patients increases the chance of achieving LDL cholesterol target values by 81% (OR 0.19).