Wind of change – PCSK9 inhibitors in hypolipidemic treatment. The Polish perspective

Abstract

Introduction and aim. Cardiovascular diseases are the main cause of mortality in the world. One of the alterable risk factors of ischaemic heart disease is dyslipidemia. Discovery and usage of a new group of drugs - PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibitors lead to a decrease of LDL-C (low-density lipoprotein cholesterol) levels in patients who are resistant to standard hypolipidemic therapy. The aim of this paper is to introduce PCSK9 inhibitors and describe their usage in medicine. 
 Material and methods. A review of the available literature was performed by searching the PubMed and GoogleScholar databases using the following key words: PCSK9 inhibitors; alirocumab; evolocumab; inclisiran. 
 Analysis of the literature. According to the European Society of Cardiology guidelines for dyslipidemias from year 2019, the main aim of dyslipidemia treatment is LDL-C reduction to target values depending on patient risk levels. It may be achieved in 2 ways, namely, by lifestyle modification or by pharmacological treatment with statins, fibrates and cholesterol absorption inhibitors. However, a therapy with PCSK9 inhibitors may be considered the most effective in certain groups of patients. Evolocumab and alirocumab are 2 representatives of those new drugs, which are allowed for use in 3 scenarios – in patients with familial hypercholesterolemia, in those with high risk of cardiovascular incident, and in those with statin intolerance. The major advantage of the aforementioned drugs is their safety. Since 2021 inclisiran (the first drug in siRNA class) is available for use as a new type of PCSK9 blocker. 
 Conclusion. PCSK9 inhibitors can be life-saving for patients with a high risk of cardiovascular incidents associated with an elevated level of LDL-C. They reduce LDL-C more efficiently and have fewer side effects in comparison with the other hypolipidemic drugs. Therefore, PCSK9 inhibitors play a very important role in the lipid-lowering treatment.