PCSK9 inhibitors – angiographically proved efficacy to stop aggressive Ischaemic Heart Disease progression : case report

Abstract

It is well established that elevated level of cholesterol is the main factor for development and progression of cardiovascular disease (CVD). Low density lipoprotein cholesterol (LDL-C) has been strongly associated with CVD. Lowering LDL-C reduces atherosclerotic disease risk and progression, irrespectively of how the reductions are achieved. The efficacy of statins is well known and proved by multiple trials. But the target LDL-C level cannot always be achieved by using maximal tolerated statin dose, overvise there are part of patients who have intolerance for statin. The new group of lipid lowering drugs - PCSK9 inhibitors (PCSK9I) is monoclonal antibodies that bind to serum PCSK9 and delay LDL receptor degradation. Two PCSK9I are commercially available: evelocumab and alirocumab. Indications to use PCSK9I include LDL-C lowering on maximally tolerated statin therapy in patients with CAD or Familial Hypercholesterolemia. We present a case report of 70 year old lady with aggressively progressive ischaemic heart disease (IHD) and intolerance to statin. Great clinical and angiographical improvement was achieved by prescribing PCSK9I.