Therapeutic Persistence in the Management of Familial Hypercholesterolemia: A Case of Acquired PCSK9 Inhibitor Nonresponse.

Familial hypercholesterolemia (FH) is an inherited disorder of lipid metabolism that causes marked elevations in low-density lipoprotein cholesterol and is associated with premature atherosclerotic cardiovascular disease. A 71-year-old woman with FH, established atherosclerotic cardiovascular disease, and statin intolerance presents to the cardiology clinic to discuss lipid management. Despite having failed combinations of statins, ezetimibe, and 2 proprotein convertase subtilisin/kexin type 9 inhibitors that use monoclonal antibodies, she was able to achieve low-risk low-density lipoprotein cholesterol levels using a novel way to lower proprotein convertase subtilisin/kexin type 9 levels with inclisiran. Therapeutic persistence is a key trait in the management of FH where multiple changes in treatment are often needed to achieve optimal therapeutic targets.