Estimated individual lifetime benefit from PCSK9 inhibition in statin-treated patients with coronary artery disease
File(s)Kaasenbrood et al Heart 2018 accepted.pdf (623.22 KB)
Accepted version
Author(s)
Type
Journal Article
Abstract
OBJECTIVE: In statin-treated patients with stable coronary artery disease (CAD), residual risk of cardiovascular events is partly explained by plasma levels of low-density lipoprotein cholesterol (LDL-C). This study aimed to estimate individual benefit of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibition in CAD patients already treated with high-dose statin. METHODS: Individual lifetime benefit was estimated in months gain free of stroke or myocardial infarction (MI) until age 80 years. Predictions were based on two competing risk models developed in data from 4853 patients with CAD originating from the atorvastatin 80 mg arm of the Treating to New Targets (TNT) trial. The relative effect of PCSK9 inhibition was added to the models and was assumed based on average estimates from large clinical trials. We accounted for individual LDL-C levels, assuming 50% LDL-C reduction by PCSK9 inhibition and 21% cardiovascular risk reduction per mmol/L (39 mg/dL) LDL-C lowering. RESULTS: Estimated individual gain was <6 months in 61% of the patients, 6-12 months in 28% of the patients and ≥12 months in 10% of the patients (median 5, quartiles 2-8 months). Highest estimated benefit was observed in younger patients (aged 40-60 years) with high risk factor burden, particularly if LDL-C levels were >1.8 mmol/L (>70 mg/dL). Estimated benefit was lowest (≤5 months) in older patients (≥70 years), in particular if LDL-C and other risk factors levels were low. CONCLUSION: The individual estimated lifetime benefit from PCSK9 inhibition in patients with stable CAD on high-dose statin varied from <6 to ≥12 months free of stroke or MI. Highest benefit is expected in younger patients (age 40-60 years) with high risk factor burden and relatively high LDL-C levels. TRIAL REGISTRATION NUMBER: NCT00327691; Post-results.
Date Issued
2018-09-27
Date Acceptance
2018-03-15
Citation
Heart, 2018, 104, pp.1699-1705
ISSN
1355-6037
Publisher
BMJ Publishing Group
Start Page
1699
End Page
1705
Journal / Book Title
Heart
Volume
104
Copyright Statement
© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/29622600
PII: heartjnl-2017-312510
Subjects
cardiac risk factors and prevention
coronary artery disease
Publication Status
Published
Coverage Spatial
England
Date Publish Online
2018-04-05