IMR Press / RCM / Volume 23 / Issue 11 / DOI: 10.31083/j.rcm2311380
Open Access Review
PCSK9 Inhibitor: Safe Alternative to Fill the Treatment Gap in Statin-Limited Conditions?
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1 Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 100037 Beijing, China
2 Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730 Beijing, China
3 Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730 Beijing, China
*Correspondence: (Yong Wang); (Jiansong Yuan)
Academic Editor: Jerome L. Fleg
Rev. Cardiovasc. Med. 2022, 23(11), 380;
Submitted: 4 August 2022 | Revised: 28 September 2022 | Accepted: 8 October 2022 | Published: 9 November 2022
Copyright: © 2022 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.

Lipid-lowering therapy is of great importance in reducing the burden of atherosclerotic cardiovascular disease. Statins act as first-line therapy in the current lipid management guidelines. However, statin use is limited in (1) statin-induced adverse events, including statin-associated muscle symptoms, new-onset diabetes mellitus, drug-induced liver injuries, acute kidney injuries, cognitive effects, hemorrhagic strokes, and cataracts; (2) special populations, including pregnant and lactating patients, patients with decompensated cirrhosis, and patients on dialysis; (3) coadministration with statin-interactive drugs, such as anti-human immunodeficiency virus drugs, anti-hepatitis C virus drugs, and immunosuppressive drugs. These considerable statin-limited groups are in urgent need of safer alternative lipid-lowering options. Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors are attracting widespread attention for their documented safety in general populations and superior lipid-lowering properties. Therefore, questions have been raised whether PCSK9 inhibitors could be a safe alternative in patients who are intolerant to statin therapy. In this review, we discuss the safety of PCSK9 inhibitors in statin-limited conditions. We conclude that PCSK9 inhibitors are a safe alternative lipid-lowering therapy in various statin-limited conditions. Furthermore, we identify several limitations in the current literature and suggest future directions, for the refinement of lipid management regimens.

cardiovascular disease
anti-PCSK9 antibody
proprotein convertase subtilisin/kexin type 9 inhibitors
adverse effects
hypolipidemic therapy
Fig. 1.
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