PCSK9 Inhibitor Indication — RACP Adult Medicine MCQ

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ModerateCardiologyPCSK9 Inhibitor IndicationRACP Adult Medicine

A 60-year-old man with established CVD (prior STEMI) on atorvastatin 80 mg and ezetimibe 10 mg has a persistent LDL-C of 2.8 mmol/L (target <1.4 mmol/L). He tolerates his medications well. He has no familial hypercholesterolaemia. What is the most appropriate next step?

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Correct answer: C — PCSK9 inhibitor (evolocumab)

Very high-risk patient (established CVD) on maximal oral lipid-lowering therapy (high-intensity statin + ezetimibe) with LDL-C persistently >1.8 mmol/L (PBS criteria: >2.6) warrants PCSK9 inhibitor (evolocumab or alirocumab). FOURIER and ODYSSEY OUTCOMES trials showed significant reduction in cardiovascular events. PCSK9 inhibitors reduce LDL-C by ~60% on top of statin. Inclisiran (siRNA targeting PCSK9 — 6-monthly injection) is an emerging alternative.

Reference: NHFA – 2024 – Lipid Management; FOURIER Trial; PBS 2024