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Canadian Journal of Cardiology

PCSK9 Inhibition Following Myocardial Infarction: A Right Time to Act

  • Alexander A. Leung
    Correspondence
    Corresponding author: Dr Alexander A. Leung, 1820 Richmond Road SW, Calgary, Alberta T2T 5C7, Canada. Tel.: +1-403-955-8358; fax: +1-403-955-8249.
    Affiliations
    Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada

    Libin Cardiovascular Institute, Cumming School of Medicine, Calgary, Alberta, Canada
    Search for articles by this author
  • Todd J. Anderson
    Affiliations
    Libin Cardiovascular Institute, Cumming School of Medicine, Calgary, Alberta, Canada

    Department of Cardiac Sciences, Cumming School of Medicine, Calgary, Alberta, Canada
    Search for articles by this author
      The first year following an acute coronary syndrome (ACS) is a vulnerable time for patients, with approximately 1 in 5 people suffering recurrent events.
      • Murphy A.
      • Hamilton G.
      • Andrianopoulos N.
      • et al.
      One-year outcomes of patients with established coronary artery disease presenting with acute coronary syndromes.
      Despite receiving standard medical therapy, many individuals have large residual risks for cardiovascular disease, especially patients belonging to very high-risk groups and those with multiple risk-enhancing factors. Although there is no doubt that lowering low-density lipoprotein cholesterol (LDL-C) is highly effective in reducing cardiovascular morbidity and mortality,
      • Sabatine M.S.
      • Wiviott S.D.
      • Im K.
      • Murphy S.A.
      • Giugliano R.P.
      Efficacy and safety of further lowering of low-density lipoprotein cholesterol in patients starting with very low levels: a meta-analysis.
      ,
      • Silverman M.G.
      • Ference B.A.
      • Im K.
      • et al.
      Association between lowering LDL-C and cardiovascular risk reduction among different therapeutic interventions: a systematic review and meta-analysis.
      many patients are unable to achieve recommended LDL-C targets with statins alone.
      • Koskinas K.C.
      • Gencer B.
      • Nanchen D.
      • et al.
      Eligibility for PCSK9 inhibitors based on the 2019 ESC/EAS and 2018 ACC/AHA guidelines.
      ,
      • Gencer B.
      • Koskinas K.C.
      • Raber L.
      • et al.
      Eligibility for PCSK9 inhibitors according to American College of Cardiology (ACC) and European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) guidelines after acute coronary syndromes.
      Up until the recent release of proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors, there have been few options to further lower LDL-C in patients already on maximally tolerated statin therapy.
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