Kaasenbrood L, et al. - In patients with stable coronary artery disease (CAD) already treated with a high-dose statin, researchers estimated individual benefit of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibition. They noted that, in these patients, the individual estimated lifetime benefit from PCSK9 inhibition varied from <6 to ≥12 months free of stroke or myocardial infarction (MI). Younger patients (age 40–60 years) with high risk factor burden and relatively high low-density lipoprotein cholesterol (LDL-C) levels are expected to benefit the most.

Methods

• Researchers estimated individual lifetime benefit in months gain free of stroke or myocardial infarction (MI) until age 80 years.
• On the basis of two competing risk models developed in data from 4,853 patients with CAD originating from the atorvastatin 80 mg arm of the Treating to New Targets trial, predictions were made.
• The relative effect of PCSK9 inhibition was added to the models and was assumed based on average estimates from large clinical trials.
• Individual LDL-C levels were accounted for, 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 gains were <6 months, 6–12 months and ≥12 months (median 5, quartiles 2–8 months) in 61%, 28% and 10% of the patients, respectively.
• Researchers noted highest estimated benefit 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).
• Older patients (≥70 years) were noted to have the lowest(≤5 months) estimated benefit, in particular if LDL-C and other risk factors levels were low.