Sustaining the Promise of PCSK9 Inhibitors: Lessons from Real-World Adherence in China

Many patients who would benefit substantially from PCSK9 inhibitors do not receive them.These PCSK9 inhibitors have consistently demonstrated potent LDL-C reduction and improved cardiovascular outcomes; however, their real-world use remains far below expectations.Multiple factors underlie this treatment gap.First, economic barriers and limited reimbursement policies have historically restricted access, particularly in Western countries, where out-of-pocket costs remain prohibitive.Second, long-term adherence is often poor even when treatment is initiated.Third, physician-related barriers persist, such as hesitancy to prescribe costly biologics and insufficient implementation of stringent LDL-C targets in daily practice.Another critical issue is the persistently low diagnosis rate of familial hypercholesterolemia (FH).FH represents one of the clearest indications for PCSK9 inhibition; however, it is vastly underdiagnosed in many countries, particularly in Asia, and Japan is no exception 1, 2) .Chinese studies have reported rates as low as 0.5%, including in large acute myocardial infarction cohorts 3) .Finally, social and educational disparities have a strong impact on real-world outcomes.As shown in this study, lower educational levels were significantly associated with poor medication adherence, highlighting the importance of health literacy and patient engagement.In this issue of the journal, Zheng et al. reported adherence rates and influencing factors after the implementation of a PCSK9 inhibitor burdenreduction program in China, and this study offers a different perspective 4) .