PCSK9 Targeted Therapy to Lower Cholesterol and Reduce Cardiovascular Events

Cardiovascular disease (CVD) is an insidious threat that requires attention. Modifying risk factors can work toward preventing the current CVD epidemic. Elevated low-density lipoprotein cholesterol (LDL-c) is a well-established and modifiable risk factor for cardiovascular, cerebrovascular, and peripheral vascular diseases. Despite receiving maximally tolerated doses of statin therapy, many Canadian patients with CVD do not achieve LDL-c targets. Additional lipid-lowering therapies, such as ezetimibe or proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i), are warranted. This paper reviews the mechanisms of action and clinical trial evidence for contemporary lipid-lowering therapies, including PCSK9 inhibitor monoclonal antibodies such as evolocumab and alirocumab, and small interfering RNA (siRNA) modulators such as inclisiran, to aid Canadian clinicians in maintaining best practices.