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Comment & Response
November 11, 2020

PCSK9 Inhibition—A Tale of 2 Potential Treatment Opportunities

Author Affiliations
  • 1Division of Cardiology, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock
JAMA Cardiol. 2021;6(4):480-481. doi:10.1001/jamacardio.2020.5606

To the Editor To our knowledge, no known medical therapy has been shown to reduce the need for aortic valve replacement in calcific aortic stenosis (AS), a disorder with an initiation phase that resembles atherosclerosis followed by a progressive phase where calcification predominates. Despite initial enthusiasm, statin use was not beneficial in slowing progression.1 We now read with great enthusiasm the results from Bergmark et al2 on their secondary analysis of 63 patients treated with evolocumab from the Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk (FOURIER) trial with new or worsening AS or need for aortic valve replacement (termed AS events). AS events were associated with higher lipoprotein(a) (Lp[a]) levels and not with corrected low-density lipoprotein cholesterol concentration and provide the mechanistic basis for evolocumab’s effect in AS.

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