Comprehensive lipid-lowering therapy and cardiovascular risk reduction: a case report

Overview

Introduction: Effective pharmacotherapy of dyslipidemia usually requires a combination of drugs. PCSK9 inhibitors the­rapy increases the chance of achieving target LDL cholesterol levels and thus reducing cardiovascular risk. Case description: A 75-year-old patient was treated for mixed dyslipidemia at very high cardiovascular risk. He had ischemic events in both the cerebral and cardiac arterial systems. Significant stenosis of the right coronary artery was treated with angioplasty and stent implantation. The patient did not tolerate statins, ezetimibe or fibrates –⁠ these drugs caused reversible elevation of creatine kinase and muscle pain. Alirocumab was well tolerated and the patient achieved target LDL cholesterol levels. Dose titration to 150 mg led to a decrease in LDL cholesterol below 1 mmol/l. Since initiation of PCSK9i the­rapy, there has been no recurrence of cardiovascular complications. Discussion: Lowering LDL cholesterol even to very low levels (< 1 mmol/l) is considered safe. The prevailing opinion in the literature is that low LDL cholesterol does not increase the risk of hemorrhagic stroke or cancer and is also safe with respect to neurocognitive functions. Conclusion: Alirocumab therapy led to achievement of the target LDL cholesterol level. The effect of the drug was observed despite the fact that alirocumab was administered as monotherapy due to intolerance of all oral hypolipidemic therapy. Titration to the maximum dose was safe, without adverse effects even when LDL cholesterol decreased below 1 mmol/l. Since initiation of PCSK9i therapy, there has been no recurrence of cardiovascular events.

Keywords:

alirocumab – PCSK9i therapy – LDL cholesterol target values