BMJ Rapid Recommendations on use of proprotein convertase subtilisin/kexin 9 inhibitors and ezetimibe to reduce cardiovascular risk

The new BMJ Rapid Recommendations addressed the following question: should we add another lipid-lowering drug in adults with low-density lipoprotein-cholesterol (LDL-C) over 1.8 mmol/L using a maximal dose of statins or intolerant to statins?1 Why is this question important? Both proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors and ezetimibe have been shown to reduce LDL-C by approximately 60% and approximately 20%, respectively, and correspondingly may reduce major adverse cardiovascular events (MACE), including all-cause death, cardiovascular death, myocardial infarction (MI) and stroke. However, the benefit of ezetimibe is small and PCSK9 inhibitors are very costly. Both drugs have adverse effects which must be considered when balancing recommendations to achieve maximal benefit and minimal harm. Current guidelines recommend differing LDL-C treatment targets. Examples of thresholds include the European Society of Cardiology (ESC) guidelines, which recommend an LDL-C target of 1.4 mmol/L for patients at very high cardiovascular risk,2 and...
Source: Heart - Category: Cardiology Authors: Tags: Editorials Source Type: research