Elserafy Ahmed Shawky, Bendary Ahmed, Elbahry Atef, Farag Elsayed, Mostafa Tamer, Sanad Osama, Elkersh Ahmed, Selim Mohammed, Ragy Hany, Khamis Hazem, Abdo Waleed, Reda Ashraf
Department of Cardiology, Ain Shams University, Cairo, Egypt.
Department of Cardiology, Benha University, Behna, Egypt.
Cardiol Ther. 2022 Dec;11(4):461-471. doi: 10.1007/s40119-022-00277-3. Epub 2022 Sep 2.
Elevation of low-density lipoprotein cholesterol (LDL-c) is still a hugely unmet need in the reduction of atherosclerotic cardiovascular disease. In the published CardioRisk project in Egypt, up to 71% of female participants had dyslipidemia. Control of LDL-c levels and thus improvement of hyperlipidemia is quite often very difficult. With the introduction of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, the decrease of significant cardiac adverse events, the patient control rate, and the death rate have all been improved. Inhibition of the formation of PCSK9 through inclisiran, which is a novel method of reducing LDL-c and is only given twice per year, seems alluring. After revision of published data, we analyzed the potential advantages of the use of inclisiran.
The Egyptian Association for Vascular Biology and Atherosclerosis (EAVA) analyzed the data necessary for obtaining clear indications for the usage of inclisiran. We propose the addition of inclisiran to statins with or without ezetimibe for patients with documented atherosclerotic cardiovascular disease (ASCVD) or similar risk, familial hypercholesterolemia (FH) with another major risk factor, and very high and high risk diabetes mellitus, who did not reach LDL-c goals and/or with true statin intolerance. Inclisiran is also recommended as upfront therapy, with triple combination, in extreme risk subjects such as those with post acute coronary syndromes (ACS).
低密度脂蛋白胆固醇（LDL-c）升高在降低动脉粥样硬化性心血管疾病方面仍是一个尚未得到充分满足的巨大需求。在埃及已发表的心脏风险项目中，高达71%的女性参与者患有血脂异常。控制LDL-c水平从而改善高脂血症往往非常困难。随着前蛋白转化酶枯草溶菌素/kexin 9型（PCSK9）抑制剂的引入，显著心脏不良事件的减少、患者控制率和死亡率均有所改善。通过inclisiran抑制PCSK9的形成，这是一种降低LDL-c的新方法，且每年只需给药两次，似乎很有吸引力。在修订已发表的数据后，我们分析了使用inclisiran的潜在优势。
埃及血管生物学和动脉粥样硬化协会（EAVA）分析了获得inclisiran使用明确指征所需的数据。我们建议，对于已确诊的动脉粥样硬化性心血管疾病（ASCVD）或具有类似风险、伴有另一个主要危险因素的家族性高胆固醇血症（FH）以及未达到LDL-c目标和/或真正不耐受他汀类药物的极高风险和高风险糖尿病患者，无论是否使用依折麦布，均可在他汀类药物基础上加用inclisiran。对于急性冠状动脉综合征（ACS）后等极高风险人群，inclisiran也推荐作为三联联合的初始治疗方案。
