title: Nonstatins and Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) Inhibitors: Role in Non-Familial Hypercholesterolemia.
abstract: After maximizing statin and lifestyle adherence, some patients may benefit from additional low-density lipoprotein cholesterol (LDL-C) lowering. The potential for net benefit from added therapy can inform nonstatin decision-making. Considering patient risk and the LDL-C level on statin, the additional potential cardiovascular disease (CVD) risk reduction benefit from further lowering LDL-C depends on the magnitude of LDL-C lowering from the nonstatin. Ezetimibe is the only nonstatin shown to reduce atherosclerotic CVD events added to a statin, albeit modestly, since it modestly reduces LDL-C by about 20%. Proprotein Convertase Subtilisin-Like/Kexin Type 9 mononclonal antibodies lower LDL-Cby 45-65%, but definitive CVD outcomes and safety trials are pending. Niacin and fenofibrate do not clearly reduce CVD events in statin-treated patients, and may increase adverse events. Bile acid sequestrants have not been evaluated in CVD outcome trials in statin-treated patients, and have an excess of adverse effects. Cost also plays a role in access to nonstatin therapy. These considerations may inform shared decision-making.
authors: Departments of Epidemiology & Medicine, Colleges of Public Health & Medicine, University of Iowa, Iowa City, Iowa. Electronic address: jennifer-g-robinson@uiowa.edu.
authors: Jennifer G
authors: JG
authors: Robinson
mesh_terms: D000924:Anticholesteremic Agents / Q000494:pharmacology; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D000066491:Clinical Decision-Making; D000069438:Ezetimibe / Q000494:pharmacology*; D006801:Humans; D006937:Hypercholesterolemia / Q000188:drug therapy*; D054539:Medication Therapy Management; D000091362:PCSK9 Inhibitors; D000071449:Proprotein Convertase 9
chemical_list: D000924:Anticholesteremic Agents; D000069438:Ezetimibe; D000091362:PCSK9 Inhibitors; C472125:PCSK9 protein, human; D000071449:Proprotein Convertase 9
keywords: Ezetimibe; PCSK9 inhibitor; Risk reduction