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Agdamag et al. Vessel Plus 2020;4:42 Vessel Plus
DOI: 10.20517/2574-1209.2020.60

Review Open Access

PCSK9 inhibitors and their use in advanced heart
failure and heart transplant recipients

Arianne Clare C. Agdamag , Valmiki R. Maharaj , Meg Fraser , Jonathan B. Edmiston , Victoria
1
1
1
2
Charpentier , Gary S. Francis , Tamas Alexy 1
1
2
1 Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN 55455, USA.
2 Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA.
Correspondence to: Dr. Tamas Alexy, Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis,
MN 55455, USA. E-mail: alexy001@umn.edu
How to cite this article: Agdamag ACC, Maharaj VR, Fraser M, Edmiston JB, Charpentier V, Francis GS, Alexy T. PCSK9 inhibitors
and their use in advanced heart failure and heart transplant recipients. Vessel Plus 2020;4:42.
http://dx.doi.org/10.20517/2574-1209.2020.60

Received: 20 Oct 2020 First Decision: 9 Nov 2020 Revised: 12 Nov 2020 Accepted: 3 Dec 2020 Published: 18 Dec 2020
Academic Editor: Ping-Yen Liu Copy Editor: Whitney Xu Production Editor: Jing Yu

Received: First Decision: Revised: Accepted: Published: x
Abstract
Science Editor: Copy Editor: Production Editor: Jing Yu The use of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors has garnered widespread attention
in the medical community over the past ten years. A number of landmark trials have demonstrated the efficacy
of PCSK9 inhibitors in lowering low-density lipoprotein (LDL) levels dramatically when added to background
statin therapy. Importantly, their use has led to a significant reduction in adverse events in patients at risk and
with established cardiovascular diseases. Published evidence is sparse in the heart failure (HF) population,
especially in those with Stage D disease. While the use of PCSK9 inhibitors has not been reported in patients with
durable mechanical circulatory support devices, limited data exist in heart transplant recipients. Management
of dyslipidemia is critically important in post-heart transplant population as it contributes to the development
of cardiac allograft vasculopathy (CAV). However, most 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA)
reductase inhibitors (statins) interfere with the metabolism of commonly used immunosuppressant agents, such
as tacrolimus. Case studies in post-heart transplant patients demonstrated significant LDL reduction with PCSK9
inhibitor use, without significant drug-drug interactions or adverse events. Two trials are currently underway
examining their efficacy in reducing CAV progression. This paper aims to review the available clinical evidence for
PCSK9 inhibitor use in HF patients, with specific focus on the advanced heart failure group.

Keywords: PCSK9 inhibitors, left ventricular assist device, heart transplant, heart failure

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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