Skill Checkup: A Man With History of Heterozygous Familial Hypercholesterolemia and Premature Coronary Heart Disease

Romesh Khardori, MD, PhD


March 17, 2023

In patients 30-75 years of age with an LDL‐C level ≥ 100 mg/dL (≥ 2.6 mmol/L) on maximally tolerated statin and ezetimibe therapy, the addition of a PCSK9 inhibitor may be considered. The monoclonal antibodies, alirocumab and evolocumab, are PCSK9 inhibitors that are administered by subcutaneous injection every 2 or 4 weeks. These agents have been shown to produce reductions in LDL-C of 50%-60% in patients with heterozygous FH. Another PCSK9 inhibitor, inclisiran, is a long-acting small interfering RNA therapeutic agent that inhibits the synthesis of PCSK9. Subcutaneous doses of inclisiran 300 mg can reduce LDL-C by > 50% for at least 6 months in patients with FH.

Two months after the addition of ezetimibe therapy, the patient returns for a follow-up visit. His LDL-C levels are still above target, and a PCSK9 inhibitor (evoculumab) is added to his treatment regimen.


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