Proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors appear to be safe and effective drugs to reduce elevated low-density lipoprotein cholesterol levels, but they will not replace conventional therapy. Two PCSK9 inhibitors, alirocumab and evolocumab, are now PBS-subsidised for patients with familial and nonfamilial hypercholesterolaemia who are at high cardiovascular risk. Because of cost constraints, patients must satisfy strict PBS criteria.
Blood lipid abnormalities, especially raised levels of low-density lipoprotein cholesterol (LDL-C), are causally related to atherosclerotic cardiovascular disease (CVD). Selected lipid interventions have been shown to reduce CVD risk. The evidence is strongest for statin drugs (i.e. inhibitors of HMG-CoA reductase),1 but also exists for the non-statin drug ezetimibe.2 The broader subject of lipid therapy was recently reviewed by this author.3