The potential role of PCSK9 inhibitors in heart transplant patients: a case series

The Proprotein convertase subtilisin/ kexin type 9 inhibitors (PCSK9i) are a novel class of lipid-lowering agents that effectively reduce low-density lipoprotein (LDL) cholesterol levels. The use of these agents has expanded to involve recipients of solid organ transplants. Method: This case series reports the safety of using PCSK9i in three patients who received heart transplants, followed up for lipid profile, and observed the incidence of coronary artery vasculopathy (CAV) over two years post-treatment. Results: Evolocumab significantly reduced the LDL level without drug interaction with the immune suppression medication. The follow-up evaluation with coronary angiogram or myocardial perfusion images confirms the freedom from CAV incidence or progression. Conclusion: PCSK9i improved the LDL profile without any adverse effect related to the combined use of immune suppressive therapy. A lack of progression of CAV was observed through diagnostic imaging modalities, suggesting a potential preventive effect of evolocumab on CAV. However, large-scale, randomized, controlled trials are needed to confirm the efficacy of PCSK9i in lowering cholesterol levels, preventing CAV, and reducing the risk of graft rejection in heart transplant (HT) recipients.