Advertisement

Proprotein Convertase Subtilisin-Kexin Type 9 inhibitors and stroke prevention: A meta-analysis

Published:January 05, 2021DOI:https://doi.org/10.1016/j.ejim.2020.11.021
      Dear Editor, over the last decades lipid-modifying strategies made a pivotal change in cardiovascular prevention especially in patients with previous coronary artery disease or ischemic stroke. In these patients, low-density lipoprotein cholesterol (LDL-C) reduction is directly correlated to less future cardiovascular events, an association mediated by its effect on the burden of atherosclerosis [
      • Cholesterol Treatment Trialists C
      • Mihaylova B
      • Emberson J
      • Blackwell L
      • Keech A
      • Simes J
      • et al.
      The effects of lowering ldl cholesterol with statin therapy in people at low risk of vascular disease: Meta-analysis of individual data from 27 randomised trials.
      ]. In contrast to coronary and peripheral artery disease which are mainly caused by atherosclerosis, stroke is a heterogenous disease with distinct pathophysiological mechanisms (like atherosclerosis, atrial fibrillation (AF), patent foramen ovale, dissection, small vessel disease) that frequently overlap [
      • Ntaios G
      • Perlepe K
      • Lambrou D
      • Sirimarco G
      • Strambo D
      • Eskandari A
      • et al.
      Prevalence and overlap of potential embolic sources in patients with embolic stroke of undetermined source.
      ]. Of them, about only 10-20% are attributed to atherosclerosis.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to European Journal of Internal Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Cholesterol Treatment Trialists C
        • Mihaylova B
        • Emberson J
        • Blackwell L
        • Keech A
        • Simes J
        • et al.
        The effects of lowering ldl cholesterol with statin therapy in people at low risk of vascular disease: Meta-analysis of individual data from 27 randomised trials.
        Lancet. 2012; 380: 581-590
        • Ntaios G
        • Perlepe K
        • Lambrou D
        • Sirimarco G
        • Strambo D
        • Eskandari A
        • et al.
        Prevalence and overlap of potential embolic sources in patients with embolic stroke of undetermined source.
        Journal of the American Heart Association. 2019; 8e012858
        • Amarenco P
        • Kim JS
        • Labreuche J
        • Charles H
        • Abtan J
        • Béjot Y
        • et al.
        A comparison of two ldl cholesterol targets after ischemic stroke.
        New England Journal of Medicine. 2019; 382: 9-19
        • Milionis H
        • Barkas F
        • Ntaios G
        • Papavasileiou V
        • Vemmos K
        • Michel P
        • et al.
        Proprotein convertase subtilisin kexin 9 (pcsk9) inhibitors to treat hypercholesterolemia: Effect on stroke risk.
        Eur. J. Intern. Med. 2016; 34: 54-57
        • Jukema JW
        • Zijlstra LE
        • Bhatt DL
        • Bittner VA
        • Diaz R
        • Drexel H
        • et al.
        Effect of alirocumab on stroke in odyssey outcomes.
        Circulation. 2019; 140: 2054-2062
      1. Giugliano RP, Pedersen TR, Saver JL, Sever PS, Keech AC, Bohula EA, et al. Stroke prevention with the pcsk9 (proprotein convertase subtilisin-kexin type 9) inhibitor evolocumab added to statin in high-risk patients with stable atherosclerosis. Stroke.0:STROKEAHA.119.027759.

        • Schwartz GG
        • Steg PG
        • Szarek M
        • Bhatt DL
        • Bittner VA
        • Diaz R
        • et al.
        Alirocumab and cardiovascular outcomes after acute coronary syndrome.
        New England Journal of Medicine. 2018; 379: 2097-2107
        • Sabatine MS
        • Giugliano RP
        • Keech AC
        • Honarpour N
        • Wiviott SD
        • Murphy SA
        • et al.
        Evolocumab and clinical outcomes in patients with cardiovascular disease.
        New England Journal of Medicine. 2017; 376: 1713-1722
        • Mach F
        • Baigent C
        • Catapano AL
        • Koskinas KC
        • Casula M
        • Badimon L
        • et al.
        2019 esc/eas guidelines for the management of dyslipidaemias: Lipid modification to reduce cardiovascular risk: The task force for the management of dyslipidaemias of the european society of cardiology (esc) and european atherosclerosis society (eas).
        European Heart Journal. 2019; 41: 111-188
        • Ntaios G
        • Ntaios G
        • Michel P
        Temporal distribution and magnitude of the vulnerability period around stroke depend on stroke subtype.
        Cerebrovascular Diseases. 2011; 32: 246-253