Title : The management of hypercholesteremia with lipid lowering therapy inclisiran
Abstract:
Increasing prevalence of cardiovascular disease leading to events such as myocardial infarction requires aggressive management of secondary prevention therapy. Lipid lowering treatments which target low density lipoprotein (LDL-C) requires advanced treatment strategies in addition to conventual statin therapy to reach guideline targets. Inclisiran a small interfering RNA (siRNA) interferes with mRNA that produces proprotein convertase substilisin kexin type 9 (PCSK9). High levels of LDL-C are associated with increased cardiovascular disease.
We evaluated the change in lipid profile in patients with cardiovascular disease being treated with inclisiran under the CVD Risk and Lipid clinic at St Bartholomew’s Hospital (SBH). Data from 170 patients was collected from the electronic medical records who are currently being offered inclisiran as part of the CVD Risk and Lipid clinic at SBH. Patients included in this analysis were in clinic from June 2022 to July 2024. Patients were analyzed for changes in LDL-C after each clinic management.
A total of 170 patients were evaluated and these patients were awaiting doses ranging from the first to the seventh inclisiran 284mg injection, the largest group being 33.7% currently awaiting their 3rd dose. 22 patients were awaiting their first dose of inclisiran and were excluded from treatment analysis. The results demonstrated an average LDL-C level at baseline amongst the 148 patients was 3.52 mmol/L. The average LDL-C at 3 months after the first dose was 1.86 mmol/L; a 42.2% decrease on average. More than 50% of patients achieved a decrease in LDL-C of 50% or more overall from baseline. The baseline treatment with the largest average decrease in LDL-C after 3 months was with ezetimibe 10mg plus bempedoic acid 180mg at 68.6%. However, the most common baseline treatment was atorvastatin 80mg with 26 patients.
Overall, the CVD Risk and Lipid Clinic reviews majority of patients across Northeast London (NEL) and has proven to be an effective clinic for patients reducing their cardiovascular risk. A significant achievement of over 50% of patients have seen an LDL-C reduction of 50% or greater supporting guideline targets of LDL-C following cardiovascular events such as a myocardial infarction. Further oral lipid lowering therapies such as conventional statins, ezetimibe, bempedoic acid and Icosapent ethyl are available options for patients who need further optimization of LDL-C reduction to achieve guideline targets.
