Xiao Ying, Ba Zhengqing, Pang Shurui, Liu Dong, Wang Hao, Liang Hanyang, Wang Yong, Yuan Jiansong
Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 100037 Beijing, China.
Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730 Beijing, China.
Rev Cardiovasc Med. 2022 Nov 9;23(11):380. doi: 10.31083/j.rcm2311380. eCollection 2022 Nov.
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.
降脂治疗在减轻动脉粥样硬化性心血管疾病负担方面具有重要意义。他汀类药物是当前血脂管理指南中的一线治疗药物。然而，他汀类药物的使用受到以下几方面限制：（1）他汀类药物引起的不良事件，包括他汀类药物相关的肌肉症状、新发糖尿病、药物性肝损伤、急性肾损伤、认知影响、出血性中风和白内障；（2）特殊人群，包括孕妇和哺乳期患者、失代偿期肝硬化患者以及透析患者；（3）与他汀类药物相互作用的药物联合使用，如抗人类免疫缺陷病毒药物、抗丙型肝炎病毒药物和免疫抑制药物。这些他汀类药物使用受限的人群迫切需要更安全的替代降脂选择。前蛋白转化酶枯草溶菌素/kexin 9型（PCSK9）抑制剂因其在普通人群中已被证实的安全性和卓越的降脂特性而受到广泛关注。因此，有人提出疑问，PCSK9抑制剂对于不耐受他汀类药物治疗的患者是否可能是一种安全的替代药物。在本综述中，我们讨论了PCSK9抑制剂在他汀类药物使用受限情况下的安全性。我们得出结论，PCSK9抑制剂在各种他汀类药物使用受限的情况下是一种安全的替代降脂疗法。此外，我们指出了当前文献中的几个局限性，并提出了未来的方向，以完善血脂管理方案。
