PCSK9 Inhibition in Acute Myocardial Infarction: A Novel Opportunity

Cory Trankle, Antonio Abbate
2016 Translational Medicine  
Editorial Acute myocardial infarction (AMI) remains a leading cause of mortality and morbidity across the nation and worldwide. While major advances in reperfusion strategies over the past several decades have significantly reduced early mortality rates after AMI, patients who survive the index event are at increasingly risk for adverse cardiac remodeling and the sequelae of heart failure and sudden cardiac death [1] . This problem is accelerated by the aging population, making heart failure a
more » ... ajor public health concern. Heart failure indeed currently affects approximately 5 million Americans, with increasing rates of prevalence and incidence. Anticoagulants, antiplatelet agents, and neurohormonal blockers are standard of care in the treatment of patients with AMI, given their established effects on morbidity and mortality. Drugs lowering low density lipoprotein (LDL) cholesterol, primarily hydroxyl-methylglutaryl-coA reductase inhibitors -statins -have been studied as a means not only to reduce LDL cholesterol (and hence the incidence of recurrent AMI), but also as an adjunct to acute AMI therapy to reduce the acute complications. In the MIRACL trial, atorvastatin 80 mg, administered within 24 to 96 hours after presentation with acute coronary syndrome (ACS), significantly reduced the composite endpoint of death, nonfatal AMI, cardiac arrest with resuscitation, or recurrent symptomatic myocardial infarction from 17.4% to 14.8% in the first 16 weeks when compared to placebo (relative risk = 0.84 [0.70 -1.00], p=0.048) [2]. 2. Schwartz GG, Olsson AG, Ezekowitz MD, Ganz P, Oliver MF et al. (2001) Effects of atorvastatin on early recurrent ischemic events in acute coronary syndromes. J Am Med Assoc 285: 1711-1718. 3. Pasceri V, Patti G, Nusca A, Pristipino C, Richichi G, et al. (2004) Randomized trial of atorvastatin for reduction of myocardial damage during coronary intervention: results from the ARMYDA (Atorvastatin for reduction of myocardial damage during angioplasty) study. Circulation 110: 674-678. 4. Patti G, Pasceri V, Colonna G, Miglionico M, Fischetti D, et al. (2007) Atorvastatin pretreatment improves outcomes in patients with acute coronary syndromes undergoing early percutaneous coronary intervention. Results of the armyda-acs randomized trial. J Am Coll Cardiol 49: 1272-1278. 5. Sabatine MS, Giugliano RP, Wiviott SD, Raal FJ, Blom DJ, et al. (2015) Efficacy and safety of evolocumab in reducing lipids and cardiovascular events. N Engl J Med 372: 1500-1509. 6. Robinson JG, Farnier M, Krempf M, Bergeron J, Luc G et al. (2015) Efficacy and safety of alirocumab in reducing lipids and cardiovascular events. N Engl
doi:10.4172/2161-1025.1000e135 fatcat:eelkfx4665fjha6wlpdpda3aim