Scientific article

Eligibility for PCSK9 inhibitors based on the 2019 ESC/EAS and 2018 ACC/AHA guidelines

Published inEuropean journal of preventive cardiology, vol. 28, no. 1, p. 59-65
Publication date2021-03-23
First online date2020-07-20

Aims: The 2018 American College of Cardiology (ACC)/American Heart Association (AHA) and 2019 European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) lipid guidelines recently updated their recommendations regarding proprotein convertase subtilisin/kexin-9 inhibitors (PCSK9i). We assessed the potential eligibility for PCSK9i according to the new guidelines in patients with acute coronary syndromes.

Methods and results: We analysed a contemporary, prospective Swiss cohort of patients hospitalised for acute coronary syndromes. We modelled a statin intensification effect and an incremental ezetimibe effect on low-density lipoprotein-cholesterol levels among patients who were not on high-intensity statins or ezetimibe. One year after the index acute coronary syndrome event, treatment eligibility for PCSK9i was defined as low-density lipoprotein-cholesterol of 1.4 mmol/l or greater according to ESC/EAS guidelines. For ACC/AHA guidelines, treatment eligibility was defined as low-density lipoprotein-cholesterol of 1.8 mmol/l or greater in the presence of very high-risk atherosclerotic cardiovascular disease, defined by multiple major atherosclerotic cardiovascular disease events and/or high-risk conditions. Of 2521 patients, 93.2% were treated with statins (53% high-intensity statins) and 7.3% with ezetimibe at 1 year, and 54.9% had very high-risk atherosclerotic cardiovascular disease. Low-density lipoprotein-cholesterol levels less than 1.8 mmol/l and less than 1.4 mmol/l at 1 year were observed in 37.5% and 15.7% of patients, respectively. After modelling the statin intensification and ezetimibe effects, these numbers increased to 76.1% and 49%, respectively. The proportion of patients eligible for PCSK9i was 51% according to ESC/EAS criteria versus 14% according to ACC/AHA criteria.

Conclusions: In this analysis, the 2019 ESC/EAS guidelines rendered half of all post-acute coronary syndrome patients potentially eligible for PCSK9i treatment, as compared to a three-fold lower eligibility rate based on the 2018 ACC/AHA guidelines.

  • Lipids
  • PCSK9 inhibitors
  • Ezetimibe
  • Secondary prevention
  • Statins
  • Atherosclerosis
  • Cardiology
  • Cardiovascular Diseases
  • Europe
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use
  • PCSK9 Inhibitors / therapeutic use
  • Practice Guidelines as Topic
  • Proprotein Convertase 9
  • Prospective Studies
  • Societies, Medical
  • United States
  • Swiss National Science Foundation - Inflammation and acute coronary syndrome (ACS) - novel strategies for prevention and clinical management
  • Swiss National Science Fondation - Inflammation and acute coronary syndrome (ACS) - novel strategies for prevention and clinical management [33CM30-140336]
Citation (ISO format)
KOSKINAS, Konstantinos C et al. Eligibility for PCSK9 inhibitors based on the 2019 ESC/EAS and 2018 ACC/AHA guidelines. In: European journal of preventive cardiology, 2021, vol. 28, n° 1, p. 59–65. doi: 10.1177/2047487320940102
Main files (1)
Article (Published version)
Secondary files (1)
ISSN of the journal2047-4873

Technical informations

Creation02/21/2022 3:32:00 PM
First validation02/21/2022 3:32:00 PM
Update time03/16/2023 8:40:43 AM
Status update03/16/2023 8:40:41 AM
Last indexation02/01/2024 9:04:06 AM
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