Inhibitors of Protein Convertase Subtilisin/Kexin 9 (PCSK9) and Acute Coronary Syndrome (ACS): The State-of-the-Art
Acute Coronary Syndrome (ACS) remains one of the most frequent causes of morbidity and mortality in the world. Although the age- and gender-adjusted incidence of ACS is decreasing, the mortality associated with this condition remains high, especially 1-year after the acute event. Several studies dem...
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| Format: | Article |
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MDPI AG
2021-04-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/10/7/1510 |
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| author | Gabriella Iannuzzo Marco Gentile Alessandro Bresciani Vania Mallardo Anna Di Lorenzo Pasquale Merone Gianluigi Cuomo Mario Pacileo Filippo M. Sarullo Elio Venturini Antonello D’Andrea Carlo Vigorito Francesco Giallauria |
| author_facet | Gabriella Iannuzzo Marco Gentile Alessandro Bresciani Vania Mallardo Anna Di Lorenzo Pasquale Merone Gianluigi Cuomo Mario Pacileo Filippo M. Sarullo Elio Venturini Antonello D’Andrea Carlo Vigorito Francesco Giallauria |
| author_sort | Gabriella Iannuzzo |
| collection | DOAJ |
| description | Acute Coronary Syndrome (ACS) remains one of the most frequent causes of morbidity and mortality in the world. Although the age- and gender-adjusted incidence of ACS is decreasing, the mortality associated with this condition remains high, especially 1-year after the acute event. Several studies demonstrated that PCSK9 inhibitors therapy determine a significant reduction of major adverse cardiovascular events (MACE) in post-ACS patients, through a process of plaque modification, by intervening in lipid metabolism and platelet aggregation and finally determining an improvement in endothelial function. In the EVACS (Evolocumab in Acute Coronary Syndrome) study, evolocumab allows >90% of patients to achieve LDL-C < 55 mg/dL according to ESC/EAS guidelines compared to 11% of patients who only receive statins. In the EVOPACS (EVOlocumab for Early Reduction of low-density lipoprotein (LDL)-cholesterol Levels in Patients With Acute Coronary Syndromes) study, evolocumab determined LDL levels reduction of 40.7% (95% CI: 45.2 to 36.2; <i>p</i> < 0.001) and allowed 95.7% of patients to achieve LDL levels <55 mg/dL. In ODYSSEY Outcome trial, alirocumab reduced the overall risk of MACE by 15% (HR = 0.85; CI: 0.78–0.93; <i>p</i> = 0.0003), with a reduced risk of all-cause mortality (HR = 0.85; CI: 0.73–0.98: nominal <i>p</i> = 0026), and fewer deaths for coronary heart disease (CHD) compared to the control group (HR = 0.92; CI: 0.76–1.11; <i>p</i> = 0.38). The present review aimed at describing the beneficial effect of PCSK9 inhibitors therapy early after ACS in reducing LDL circulating levels (LDL-C) and the risk of major adverse cardiovascular events, which was very high in the first year and persists higher later after the acute event. |
| first_indexed | 2024-03-10T12:37:14Z |
| format | Article |
| id | doaj.art-f0cfcdbcc70c40dba9bea9a889d3a53c |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T12:37:14Z |
| publishDate | 2021-04-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-f0cfcdbcc70c40dba9bea9a889d3a53c2023-11-21T14:14:50ZengMDPI AGJournal of Clinical Medicine2077-03832021-04-01107151010.3390/jcm10071510Inhibitors of Protein Convertase Subtilisin/Kexin 9 (PCSK9) and Acute Coronary Syndrome (ACS): The State-of-the-ArtGabriella Iannuzzo0Marco Gentile1Alessandro Bresciani2Vania Mallardo3Anna Di Lorenzo4Pasquale Merone5Gianluigi Cuomo6Mario Pacileo7Filippo M. Sarullo8Elio Venturini9Antonello D’Andrea10Carlo Vigorito11Francesco Giallauria12Department of Clinical Medicine and Surgery, “Federico II” University, 80131 Naples, ItalyDepartment of Clinical Medicine and Surgery, “Federico II” University, 80131 Naples, ItalyDepartment of Medicine and Medical Specialties, A. Cardarelli Hospital, 80131 Naples, ItalyDepartment of Clinical Medicine and Surgery, “Federico II” University, 80131 Naples, ItalyDepartment of Translational Medical Sciences, “Federico II” University of Naples, Via S. Pansini 5, 80131 Naples, ItalyDepartment of Translational Medical Sciences, “Federico II” University of Naples, Via S. Pansini 5, 80131 Naples, ItalyDepartment of Translational Medical Sciences, “Federico II” University of Naples, Via S. Pansini 5, 80131 Naples, ItalyUnit of Cardiology and Intensive Care, “Umberto I” Hospital, Viale San Francesco, 84014 Nocera Inferiore, ItalyCardiovascular Rehabilitation Unit, Buccheri La Ferla Fatebenefratelli Hospital, 90123 Palermo, ItalyCardiac Rehabilitation Unit, Azienda USL Toscana Nord-Ovest, Cecina Civil Hospital, 57023 Cecina, ItalyUnit of Cardiology and Intensive Care, “Umberto I” Hospital, Viale San Francesco, 84014 Nocera Inferiore, ItalyDepartment of Translational Medical Sciences, “Federico II” University of Naples, Via S. Pansini 5, 80131 Naples, ItalyDepartment of Translational Medical Sciences, “Federico II” University of Naples, Via S. Pansini 5, 80131 Naples, ItalyAcute Coronary Syndrome (ACS) remains one of the most frequent causes of morbidity and mortality in the world. Although the age- and gender-adjusted incidence of ACS is decreasing, the mortality associated with this condition remains high, especially 1-year after the acute event. Several studies demonstrated that PCSK9 inhibitors therapy determine a significant reduction of major adverse cardiovascular events (MACE) in post-ACS patients, through a process of plaque modification, by intervening in lipid metabolism and platelet aggregation and finally determining an improvement in endothelial function. In the EVACS (Evolocumab in Acute Coronary Syndrome) study, evolocumab allows >90% of patients to achieve LDL-C < 55 mg/dL according to ESC/EAS guidelines compared to 11% of patients who only receive statins. In the EVOPACS (EVOlocumab for Early Reduction of low-density lipoprotein (LDL)-cholesterol Levels in Patients With Acute Coronary Syndromes) study, evolocumab determined LDL levels reduction of 40.7% (95% CI: 45.2 to 36.2; <i>p</i> < 0.001) and allowed 95.7% of patients to achieve LDL levels <55 mg/dL. In ODYSSEY Outcome trial, alirocumab reduced the overall risk of MACE by 15% (HR = 0.85; CI: 0.78–0.93; <i>p</i> = 0.0003), with a reduced risk of all-cause mortality (HR = 0.85; CI: 0.73–0.98: nominal <i>p</i> = 0026), and fewer deaths for coronary heart disease (CHD) compared to the control group (HR = 0.92; CI: 0.76–1.11; <i>p</i> = 0.38). The present review aimed at describing the beneficial effect of PCSK9 inhibitors therapy early after ACS in reducing LDL circulating levels (LDL-C) and the risk of major adverse cardiovascular events, which was very high in the first year and persists higher later after the acute event.https://www.mdpi.com/2077-0383/10/7/1510acute coronary syndromePCSK9 inhibitorscardiovascular risk |
| spellingShingle | Gabriella Iannuzzo Marco Gentile Alessandro Bresciani Vania Mallardo Anna Di Lorenzo Pasquale Merone Gianluigi Cuomo Mario Pacileo Filippo M. Sarullo Elio Venturini Antonello D’Andrea Carlo Vigorito Francesco Giallauria Inhibitors of Protein Convertase Subtilisin/Kexin 9 (PCSK9) and Acute Coronary Syndrome (ACS): The State-of-the-Art Journal of Clinical Medicine acute coronary syndrome PCSK9 inhibitors cardiovascular risk |
| title | Inhibitors of Protein Convertase Subtilisin/Kexin 9 (PCSK9) and Acute Coronary Syndrome (ACS): The State-of-the-Art |
| title_full | Inhibitors of Protein Convertase Subtilisin/Kexin 9 (PCSK9) and Acute Coronary Syndrome (ACS): The State-of-the-Art |
| title_fullStr | Inhibitors of Protein Convertase Subtilisin/Kexin 9 (PCSK9) and Acute Coronary Syndrome (ACS): The State-of-the-Art |
| title_full_unstemmed | Inhibitors of Protein Convertase Subtilisin/Kexin 9 (PCSK9) and Acute Coronary Syndrome (ACS): The State-of-the-Art |
| title_short | Inhibitors of Protein Convertase Subtilisin/Kexin 9 (PCSK9) and Acute Coronary Syndrome (ACS): The State-of-the-Art |
| title_sort | inhibitors of protein convertase subtilisin kexin 9 pcsk9 and acute coronary syndrome acs the state of the art |
| topic | acute coronary syndrome PCSK9 inhibitors cardiovascular risk |
| url | https://www.mdpi.com/2077-0383/10/7/1510 |
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