Proprotein convertase Subtilisin-Kexin type 9 (PCSK9) inhibitors and cardiovascular risk: does a further analysis of the fourier trial suggest changes in the target of lipid lowering therapy?

Dyslipidemia is a relatively common cardiovascular risk factor in the general population, particularly in elderly individuals and in those patients at high or very high cardiovascular risk profile. This condition heavily affects the risk of developing major cardiovascular events, mostly myocardil infarction, coronary disease, stroke, congestive heart failure and renal disease. Several observational studies have demonstrated a strong and independent predictive role of both total and LDL cholesterol levels for major cardiovascular events. On the other hand, randomized controlled clinical trials have convincingly and independently demonstrated beneficial the effects of lowering cholesterol levels in terms of reduced risk of cardiovascular morbidity and mortality. In particular, recent trials provided further evidence in favor of beneficial effects of extremely low reductions of LDL cholesterol levels with combination therapies based on statins plus ezetimibe or Proprotein Convertase Subtilisin-Kexin Type 9 (PCSK9) Inhibitors.