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Vol. 72. Issue 6.
Pages 519-520 (June 2019)
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Vol. 72. Issue 6.
Pages 519-520 (June 2019)
Letter to the Editor
DOI: 10.1016/j.rec.2018.12.009
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Estimated Percentage of Patients With Stable Coronary Heart Disease Candidates for PCSK9 Inhibitors. Response
Estimación del porcentaje de pacientes con enfermedad coronaria estable candidatos a recibir inhibidores de PCSK9. Respuesta
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Alberto Zamoraa,b,c, Luis Masanab,d, Nuria Planab,d, Rafel Ramose,f,g,
Corresponding author
rramos.girona.ics@gencat.cat

Corresponding author:
a Laboratorio de Medicina Traslacional, Departamento de Ciencias Médicas, Facultad de Medicina, Universidad de Girona, Girona, Spain
b Xarxa d’Unitats de Lípids de Catalunya (XULA), Girona, Spain
c Unidad de Lípidos, Hospital de Blanes, Blanes, Girona, Spain
d Unitat de Medicina Vascular i Metabolisme (UVASMET), Hospital Universitari Sant Joan de Reus, Institut d’Investigació Sanitària Pere Virgili (IISPV), Universitat Rovira i Virgili, Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Reus, Tarragona, Spain
e Grup Investigació en Salut Cardiovascular de Girona (ISV-Girona), Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Girona, Spain
f Institut d’Investigació Biomédica de Girona (IdIBGi), Institut Catalá de la Salut (ICS), Girona, Spain
g Departamento de Ciencias Médicas, Facultad de Medicina, Universidad de Girona, Girona, Spain
Related content
Rev Esp Cardiol. 2019;72:518-910.1016/j.rec.2018.11.018
Alberto Cordero, Lorenzo Fácila, Enrique Galve, José Ramón González Juanatey
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To the Editor,

?We agree with Cordero et al. that, in absolute numbers, patients with CVD form the largest subgroup eligible for treatment with proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i). In our study, 84% of PCSK9i-eligible patients had CVD.1 Treatment optimization in Spain would likely reduce the number of PCSK9i-eligible patients by roughly 50%. The REPAR study has shown the effectiveness of combination lipid-lowering therapy. Nevertheless, in our study, only between 1.9% and 6.6% of patients with CVD received this therapy.1

The studies by Fourier2 and Odissey3 demonstrate that the addition of PCSK9i reduces primary or secondary endpoints by 15% to 20% among CVD patients on optimal lipid-lowering therapy. The CVD patient groups that would benefit most from PCSK9i therapy include those with recurrent events (number needed to treat [NNT]=38), an event in the last 2 years (NNT=35), multivessel disease (NNT=29), concomitant peripheral aterial disease (NNT=29), or recent ischemic heart disease concomitant with low-density lipoprotein cholesterol>100 mg/dL (NNT=16).4 Even in the setting of statin therapy, patients with familial hypercholesterolemia have a 3-fold higher prevalence of CVD than unaffected relatives.4

Data from the Departament de Salut de Catalunya indicate that 560 patients were treated with PCSK9i from their commercial launch until March 2018. This number corresponds to between 1.05% and 3.4% of eligible patients, indicating that many patients who could benefit from PCSK9i therapy are not receiving it.

It is incumbent upon all stakeholders to work to redefine shared criteria for the indication of PCSK9i therapy.

FUNDING

This study received funding from the Spanish Ministry of the Economy through the Instituto de Salud Carlos III (Red de Investigación Cardiovascular Programa HERACLES RD12/0042 and Red RedIAPP RD12/0007 and the CIBERCV), the European Regional Development Fund (ERDF-FEDER), and the Generalitat de Catalunya through the Agència de Gestió Ajuts Universitaris de Recerca (2014 SGR 240 and 2014 SGR 902) and the Agència de Qualitat i Avaluació Sanitàries de Catalunya, Pla Estratègic de Recerca i Innovació en Salut (PERIS) (SLT002/16/00145).

CONFLICTS OF INTEREST

L. Masana has received fees from Amgen, Sanofi, Daichii, and Mylan for activities unrelated to the present study.

References
[1]
A. Zamora, L. Masana, M. Comas-Cufi, et al.
Número de pacientes candidatos a recibir inhibidores de la PCSK9 según datos de 2,5 millones de participantes de la práctica clínica real.
Rev Esp Cardiol., 71 (2018), pp. 1010-1017
[2]
M.S. Sabatine, R.P. Giugliano, A.C. Keech, et al.
Evolocumab and clinical outcomes in patients with cardiovascular disease.
N Engl J Med., 376 (2017), pp. 1713-1722
[3]
G.G. Schwartz, P.G. Steg, M. Szarek, et al.
Alirocumab and cardiovascular outcomes after acute coronary syndrome.
N Engl J Med., 379 (2018 29), pp. 2097-2107
[4]
L. Pérez de Isla, R. Alonso, N. Mata, et al.
Coronary heart disease, peripheral arterial disease, and stroke in familial hypercholesterolaemia: insights from the SAFEHEART Registry (Spanish Familial Hypercholesterolaemia Cohort Study).
Arterioscler Thromb Vasc Biol., 36 (2016), pp. 2004-2010
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Revista Española de Cardiología (English Edition)

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