PCSK9 Inhibitors Are Potential Alternatives to Statins in Patients with High Risk of Intracerebral Hemorrhage
Praveen Hariharan, MD
Since the birth of statins in the late 20th century, statins have become an integral part of cardiovascular disease management. However, several studies showing increased risk of hemorrhagic stroke with statin use have raised concerns, and the risk is currently being evaluated with ongoing randomized clinical trials. PCSK9 (proprotein convertase subtilisin kexin 9) inhibitors are the most potent novel antihyperlipidemic medications and could serve as potential alternatives to statins.
In this study, Drs. Sanz-Cuesta and Saver investigated the hemorrhagic stroke rates of PCSK9 inhibitors by undertaking a meta-analysis of data available from randomized clinical trials (RCTs) comparing low or high dose statins with each other or controls, and low and high dose PCSK9 inhibitors with each other or controls. Assuming a gradient risk based on the history of ischemic or hemorrhagic stroke and medication dosing, RCTs were planned to be grouped into 4 subcategories: 1) all patients/any dose; 2) all patients/high dose; 3) history of ischemic stroke/any dose; and 4) history of hemorrhagic stroke/any dose.