The effect of proprotein convertase subtilisin kexin type 9 inhibitors on the survival of patients at extreme cardiovascular risk in real clinical practice

BACKGROUND: Among non-communicable diseases, cardiovascular diseases occupy a leading position in terms of mortality rate in developed countries, including Russia. In the clinical practice of the Russian Federation, almost all modern methods and means of treating patients with cardiovascular diseases are used. In particular, innovative lipid-lowering drugs are used, such as proprotein convertase inhibitors subtilisin/kexin type 9 — alirocumab and evolocumab. However, at the moment there is no complete information on how these drugs affect the survival of patients at extreme cardiovascular risk, both worldwide and in Russia. In this regard, the study of this issue is an important and urgent task.

AIM: To evaluate the efficacy and safety of proprotein convertase inhibitors subtilisin / kexin type 9 in patients at extreme cardiovascular risk. Also, to assess the effect of these drugs on the survival of patients of this category of cardiovascular risk.

MATERIAL AND METHODS: The study involved 104 patients at extreme cardiovascular risk. The patients were divided into two groups: the main group (53 people) and the control group (51 people). In the control group, the patients received standard lipid-lowering therapy: statin at the maximum tolerated dosage and/or ezetimibe, and in the main group, standard lipid-lowering therapy was supplemented with drugs of proprotein convertase inhibitors subtilisin/kexin type 9.

The results of laboratory research methods were analyzed in dynamics, and the frequency of side effects was evaluated. All cases of cardiovascular events, including mortality, were recorded. Based on the data obtained, we analyzed the survival rate and frequency of major cardiovascular events.

RESULTS: In the main group, month after starting therapy with proprotein convertase inhibitors subtilisin/kexin type 9, the level of low-density lipoproteins in all the patients decreased by more than 50% from the initial value. The target level of low-density lipoproteins was reached by 42 out of 53 observed patients. These results remained stable until the end of the study. No cases of hepatotoxicity, myopathy, or other local side effects were reported during the period of use of proprotein convertase inhibitors subtilisin/kexin type 9. In the control group, the lipidogram of patients did not change significantly during the study. In addition, there were more cases of recurrent cardiovascular events, including mortality, in the patients in the control group.

CONCLUSIONS: In real clinical practice, proprotein convertase inhibitors subtilisin / kexin type 9 has demonstrated high efficacy and safety in patients at extreme cardiovascular risk. Thanks to the use of these drugs, it was possible to achieve the target levels of low-density lipoproteins and increase patient’s adherence to treatment. As a result, the prognosis for patients with an extreme risk of cardiovascular complications improved.