New lipid therapies: PCSK9 inhibitors

Pharmacologic therapy reduces cardiovascular risk in a variety of primary and secondary prevention clinical situations in addition to lifestyle modifications. Low density lipoprotein cholesterol (LDL-C) is a key mediator of atherogenesis. Most cholesterol guidelines propose specific LDL-C while recently the ACC/AHA recommends statin therapy without a specific LDL-C target. Proprotein convertase subtilisin kexin 9 (PCSK9) is a serine protease that leads to LDL receptor degradation. The decreased availability of LDL receptors results in decreased clearance and an increase of circulating LDL-C particles. Monoclonal antibodies that inhibit PCSK9 (PCSK9 abs) reduce LDL-C levels and may be especially helpful in familial hypercholesterolemia and statin-intolerant patients. PCSK9 inhibition is an exciting and promising new therapy for protection against macrovascular events.