Atherosclerotic Cardiovascular Disease, Unmet Needs, and Inclisiran
DOI:
https://doi.org/10.24950/rspmi.1603Keywords:
Anticholesteremic Agents/therapeutic use, Atherosclerosis/drug therapy, Cardiovascular Diseases/drug therapy, Cardiovascular Diseases/prevention & control, Hypercholesterolemia/ drug therapy, RNA, Small Interfering/therapeutic useAbstract
The leading cause of death and disability worldwide are
due to atherosclerotic cardiovascular disease (ASCVD), entailing a heavy economic impact, in Portugal corresponding to 1% of the gross domestic product. The development and progression of ASCVD are closely related to hypercholesterolaemia, with high LDL-C levels being its most important and easily modifiable risk factor. Reducing LDL-C has been shown to decrease the incidence of cardiovascular events and European recommendations advocate LDL-C target values according to the patient's cardiovascular risk. The risk of hypercholesterolaemia is cumulative, making it relevant to reduce LDL-C as early as possible.
Despite the efficacy and safety demonstrated by several
existing lipid-lowering therapies, in the real world most patients do not achieve the recommended lipid values. Several limitations to adequate lipid control have been pointed out, namely the low adherence of patients to treatment.
Inclisiran is the first drug to inhibit PCSK9 synthesis through
RNA small interference mechanism. With a subcutaneous
administration every six months after initial and 3-month dose, it allows a LDL-C reduction higher than 50%, with a good safety profile. The advantage of its long duration of action will potentially overcome the low compliance of patients to treatment and increase the effectiveness in reducing LDL-C, which may translate into a reduction in morbidity and mortality from ASCVD and its high economic impact.
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