​A New Hope for Dyslipidemia and Cardiovascular Disease

Despite all we know about the mechanism, risk factors, and treatment of cardiovascular disease (CVD), it still ranks among the top killers of people in the United States and around the world. We know that high levels of low-density lipoprotein cholesterol (LDL-C) contribute to the development of CVD, and that LDL-C levels are a modifiable risk factor—they can be lowered through diet, exercise, and pharmacotherapy, particularly statins.

But many people continue to have persistently elevated LDL-C levels despite aggressive statin therapy because of existing conditions such as familial hypercholesterolemia; others are unable to tolerate statins because of their rare adverse effects such as myalgia. A new class of medications—monoclonal antibody inhibitors of proprotein convertase subtilisin-like kexin type 9 (PCSK9)—may offer hope for the successful lowering of LDL-C in these people.

As B. Alan Bottenberg, DO, and Michael J. Bloch, MD, write in their feature article beginning on page 324, “PCSK9 inhibitors have thus far demonstrated tremendous efficacy in lowering LDL-C with an excellent safety and tolerability profile. … [They] appear to be uniquely positioned to become an important part of our armamentarium in the treatment of dyslipidemia and cardiovascular risk.”

They note that based on the very encouraging results of clinical trials conducted to date, PCSK9 inhibitors might be able to cut LDL-C by as much as 70% beyond levels achieved with statins alone. In just a few years, more definitive results, from clinical outcomes studies and other research, will allow the value of these lipid-lowering medications and their place in clinical care.

Despite the real potential for a new life-extending or even lifesaving option for the treatment of dyslipidemia and associated CVD, we must temper expectations. After all, statins have been proven to lower LDL-C; still, since the debut of this class in the late 1980s, some note that CVD deaths have not appeared to decrease significantly. One set of authors wrote (under the memorable headline, “Why statins have failed to reduce mortality in just about anybody”) that “[W]e must question the way statins work because they effectively do not prevent cardiovascular and all-cause deaths.”1

We’ll report breaking news about PCSK9 inhibitors at Consultant360.com, and you’ll likely hear more about this hopeful new class of medications at the Cardiometabolic Risk Summit, powered by Consultant, which will take place October 14-16 in Las Vegas (go to www.primarycarecardiometabolic.com/fall, or follow the links at Consultant360 to register). We at Consultant are committed to bringing you and your colleagues in primary care practical information on the latest medical approaches to patient care, like the PCSK9 feature and the rest of the peer-reviewed information in this and every issue.

Send me a note at Editor@Consultant360.com, or call me toll-free at (800) 237-7285, extension 4396. Thanks for reading.

Michael Gerchufsky, ELS, CMPP
Managing Editor, Consultant


Vos E, Rose CP, Biron P. Point: why statins have failed to reduce mortality in just about anybody. J Clin Lipidol. 2013;7(3):222-224.