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Diseases 2018, 6(2), 45; https://doi.org/10.3390/diseases6020045

CVD Risk Stratification in the PCSK9 Era: Is There a Role for LDL Subfractions?

1
Division of Internal Medicine, Nordland Hospital, N-8092 Bodø, Norway
2
Department of Clinical Medicine, University of Tromsø, N-9037 Tromsø, Norway
*
Author to whom correspondence should be addressed.
Received: 4 May 2018 / Revised: 23 May 2018 / Accepted: 24 May 2018 / Published: 27 May 2018
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Abstract

Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors reduce the risk of cardiovascular events and all-cause mortality in patients at high risk of cardiovascular disease (CVD). Due to high costs and unknown long-term adverse effects, critical evaluation of patients considered for PCSK9 inhibitors is important. It has been proposed that measuring low-density lipoprotein (LDL) subfractions, or LDL particle numbers (LDL-P), could be of value in CVD risk assessment and may identify patients at high risk of CVD. This review evaluates the evidence for the use of LDL subfractions, or LDL-P, when assessing CVD risk in patients for whom PCSK9 inhibitors are considered as a lipid-lowering therapy. Numerous methods for measuring LDL subfractions and LDL-P are available, but several factors limit their availability. A lack of standardization makes comparison between the different methods challenging. Longitudinal population-based studies have found an independent association between different LDL subfractions, LDL-P, and an increased risk of cardiovascular events, but definitive evidence that these measurements add predictive value to the standard risk markers is lacking. No studies have proven that these measurements improve clinical outcomes. PCSK9 inhibitors seem to be effective at lowering all LDL subfractions and LDL-P, but any evidence that measuring LDL subfractions and LDL-P yield clinically useful information is lacking. Such analyses are currently not recommended when considering whether to initiate PCKS9 inhibitors in patients at risk of CVD. View Full-Text
Keywords: PCSK9; proprotein convertase subtilisin/kexin type 9; LDL subfractions; sdLDL; cardiovascular disease; risk stratification PCSK9; proprotein convertase subtilisin/kexin type 9; LDL subfractions; sdLDL; cardiovascular disease; risk stratification
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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).
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Kjellmo, C.A.; Hovland, A.; Lappegård, K.T. CVD Risk Stratification in the PCSK9 Era: Is There a Role for LDL Subfractions? Diseases 2018, 6, 45.

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