Initial Clinical Experience with PCSK9 Inhibitors to Lower LDL Cholesterol in a University Lipid Clinic Setting

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Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have demonstrated significant lowering of low-density lipoprotein (LDL) cholesterol in patients with atherosclerotic cardiovascular disease (ASCVD) and familial hypercholesterolemia (FH). We retrospectively reviewed data concerning use of PCSK9 inhibitors from patients in our university-based adult lipid clinic. Data collected included clinical pre-treatment variables and pre-and post-treatment non-fasting lipid profiles. Of 165 candidates, 163 were approved for PCSK9 inhibition (90% ASCVD and 10% FH). A majority of patients (72%) had statin intolerance. Treatment was provided and assessed in 141 patients. After three doses of medications, LDL cholesterol fell from 170 + 58 mg/dL to 76 + 45 mg/dL (55%, P<0.001). There were no differences in efficacy according to sex, elevated lipoprotein(a), and the PCS-K9 inhibitor utilized. Continued efficacy was evaluated in 101 patients with LDL decreasing further from initial follow-up to long-term follow-up over an average of 14 months (74 ± 44 mg/dL to 68 ± 41 mg/dL). Permanent discontinuation of PCS-K9 inhibitor because of side effects occurred in 11% of patients. When strict adherence to guidelines was applied, >95% approval rate was obtained, and there was similar efficacy in LDL lowering to what has been previously reported irrespective of statin intolerance.