ABC | Volume 111, Nº1, July 2018

Viewpoint Behr et al PCSK9 in patients at cardiovascular risk Arq Bras Cardiol. 2018; 111(1):104-108 16 12 8 4 40 50 80 90 120 120 160 160 67 LDL-c (mg/dL) –25% –25% –25% –25% –20% –15% –11% –8% Absolute cardiovascular risk (%) 15 12 10.2 9.1 8.3 Figure 1 – Absolute risk reduction for the same relative LDL-C level reduction from different initial LDL-C levels. (Reprint with permission from Oxford University Press). 17 Table 1 – NNT in 5 years to prevent a cardiovascular (CV) event in “high” and “very high CV risk” individuals receiving treatment with high‑potency statins by adding the PCSK9 inhibitor (PCSK9-I) Initial LDL-C 50% reduction in LDL-C (with PCSK9-I) 65% reduction in LDL-C (with PCSK9-I) High risk (20-29% risk of ACVD in 10 years) 190 19 15 160 23 18 130 28 22 100 37 28 70 53 40 Very high risk (risk of ACVD in 10 years ≥ 30%) 190 13 10 160 15 12 130 19 15 100 25 19 70 35 27 LDL-C: low-density-lipoprotein cholesterol; PCSK9: proprotein convertase subtilisin/kexin type 9; ACVD: atherosclerotic cardiovascular disease. (Table adapted with permission from Elsevier). 16 Therefore, patients at high CV risk, plainly treated with high-potency statin associated with ezetimibe, and whose LDL-C levels are higher than 130 mg/dL, will significantly reduce their risk of CV events by adding PCSK9-I to their treatment. Similarly, individuals at very high CV risk, treated with statin and ezetimibe, and whose LDL-C levels are higher than 100 mg/dl, have a very good chance of significantly reducing outcomes and the residual CV risk by adding that new class of drugs to their treatment. 106