Fontes-Carvalho Ricardo, Marques Silva Pedro, Rodrigues Elisabete, Araújo Francisco, Gavina Cristina, Ferreira Jorge, Morais João
Departamento de Cardiologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal; Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
Núcleo de Investigação Arterial, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisboa, Portugal.
Rev Port Cardiol (Engl Ed). 2019 Jun;38(6):391-405. doi: 10.1016/j.repc.2019.05.005. Epub 2019 Jul 16.
Reducing low-density lipoprotein cholesterol (LDL-C) levels is one of the most important strategies for reducing the risk of cardiovascular events. However, in clinical practice, a high proportion of patients do not achieve recommended LDL-C levels through lifestyle and lipid-lowering therapy with statins and ezetimibe. PCSK9 inhibitors (PCSK9i) are a new therapeutic option that significantly (50-60%) reduces LDL-C levels, which in clinical trials translates into an additional reduction in risk for cardiovascular events, and has a good safety profile. However, it is a high-cost therapy, and therefore its use in clinical practice should take its cost-effectiveness into account. Priority should be given to use in patients at higher cardiovascular risk and those in whom high LDL-C levels persist despite optimal lipid-lowering therapy. This consensus document aims to summarize the main data on the clinical use of PCSK9i and to make recommendations for Portugal on the profile of patients who may benefit most from this therapy.
降低低密度脂蛋白胆固醇（LDL-C）水平是降低心血管事件风险的最重要策略之一。然而，在临床实践中，很大一部分患者通过生活方式调整以及使用他汀类药物和依折麦布进行降脂治疗，仍无法达到推荐的LDL-C水平。前蛋白转化酶枯草溶菌素9抑制剂（PCSK9i）是一种新的治疗选择，可显著（50%-60%）降低LDL-C水平，在临床试验中这转化为心血管事件风险的进一步降低，并且具有良好的安全性。然而，这是一种高成本治疗方法，因此在临床实践中使用时应考虑其成本效益。应优先用于心血管风险较高以及尽管接受了最佳降脂治疗但LDL-C水平仍持续升高的患者。本共识文件旨在总结PCSK9i临床应用的主要数据，并就葡萄牙可能从该治疗中获益最大的患者特征提出建议。
