Treatment of hypercholesterolaemia with PCSK9 inhibitors in patients after cardiac transplantation.

<h4>Background</h4>Hypercholesterolaemia is common in patients after cardiac transplantation. Monoclonal antibodies that inhibit proprotein convertase subtilisin-kexin type 9 (PCSK9) reduce low-density lipoprotein (LDL) cholesterol levels and subsequently the risk of cardiovascular event...

Full description

Bibliographic Details
Main Authors: Michael Kühl, Christian Binner, Joanna Jozwiak, Julia Fischer, Jochen Hahn, Alaeldin Addas, Boris Dinov, Jens Garbade, Gerhard Hindricks, Michael Borger
Format: Article
Language:English
Published: Public Library of Science (PLoS) 2019-01-01
Series:PLoS ONE
Online Access:https://doi.org/10.1371/journal.pone.0210373
id doaj-2c56e17c5c2f4607b7412f9977ebdf66
record_format Article
spelling doaj-2c56e17c5c2f4607b7412f9977ebdf662021-03-04T10:37:39ZengPublic Library of Science (PLoS)PLoS ONE1932-62032019-01-01141e021037310.1371/journal.pone.0210373Treatment of hypercholesterolaemia with PCSK9 inhibitors in patients after cardiac transplantation.Michael KühlChristian BinnerJoanna JozwiakJulia FischerJochen HahnAlaeldin AddasBoris DinovJens GarbadeGerhard HindricksMichael Borger<h4>Background</h4>Hypercholesterolaemia is common in patients after cardiac transplantation. Monoclonal antibodies that inhibit proprotein convertase subtilisin-kexin type 9 (PCSK9) reduce low-density lipoprotein (LDL) cholesterol levels and subsequently the risk of cardiovascular events in patients with dyslipidaemia. There are no published data on the effect of this medication class on cholesterol levels in patients after cardiac transplantation.<h4>Methods</h4>In this retrospective study we investigated patients who were treated with PCSK9 inhibitors either because of intolerance of statins or residual hypercholesterolaemia with evidence of cardiac allograft vasculopathy. We compared the data of patients prior to the start with these medications with their most recent dataset.<h4>Results</h4>Ten patients (nine men; mean age 58±6 years) underwent cardiac transplantation 8.3±4.5 (range 3-15) years ago. The treatment duration of Evolocumab or Alirocumab was on average 296±125 days and lead to a reduction of total Cholesterol (281±52 mg/dl to 197±36 mg/dl; p = 0.002) and LDL Cholesterol (170±22 mg/dl to 101±39 mg/dl; p = 0.001). No significant effects on HDL Cholesterol, BNP, Creatin Kinase or hepatic enzymes were noticed. There were no unplanned hospitalisations, episodes of rejections, change of ejection fraction or opportunistic infections. Both patients on Alirocumab developed liver pathologies: One patient died of hepatocellular carcinoma and the other developed hepatitis E.<h4>Conclusions</h4>Our study demonstrates that the PCSK9 inhibitors Evolocumab and Alirocumab lead to a significant reduction of LDL Cholesterol in heart transplantation recipients. No effect on cardiac function or episodes of rejections were noticed. Larger and long-term studies are needed to establish safety and efficacy of PCSK9 inhibitors after cardiac transplantation.https://doi.org/10.1371/journal.pone.0210373
collection DOAJ
language English
format Article
sources DOAJ
author Michael Kühl
Christian Binner
Joanna Jozwiak
Julia Fischer
Jochen Hahn
Alaeldin Addas
Boris Dinov
Jens Garbade
Gerhard Hindricks
Michael Borger
spellingShingle Michael Kühl
Christian Binner
Joanna Jozwiak
Julia Fischer
Jochen Hahn
Alaeldin Addas
Boris Dinov
Jens Garbade
Gerhard Hindricks
Michael Borger
Treatment of hypercholesterolaemia with PCSK9 inhibitors in patients after cardiac transplantation.
PLoS ONE
author_facet Michael Kühl
Christian Binner
Joanna Jozwiak
Julia Fischer
Jochen Hahn
Alaeldin Addas
Boris Dinov
Jens Garbade
Gerhard Hindricks
Michael Borger
author_sort Michael Kühl
title Treatment of hypercholesterolaemia with PCSK9 inhibitors in patients after cardiac transplantation.
title_short Treatment of hypercholesterolaemia with PCSK9 inhibitors in patients after cardiac transplantation.
title_full Treatment of hypercholesterolaemia with PCSK9 inhibitors in patients after cardiac transplantation.
title_fullStr Treatment of hypercholesterolaemia with PCSK9 inhibitors in patients after cardiac transplantation.
title_full_unstemmed Treatment of hypercholesterolaemia with PCSK9 inhibitors in patients after cardiac transplantation.
title_sort treatment of hypercholesterolaemia with pcsk9 inhibitors in patients after cardiac transplantation.
publisher Public Library of Science (PLoS)
series PLoS ONE
issn 1932-6203
publishDate 2019-01-01
description <h4>Background</h4>Hypercholesterolaemia is common in patients after cardiac transplantation. Monoclonal antibodies that inhibit proprotein convertase subtilisin-kexin type 9 (PCSK9) reduce low-density lipoprotein (LDL) cholesterol levels and subsequently the risk of cardiovascular events in patients with dyslipidaemia. There are no published data on the effect of this medication class on cholesterol levels in patients after cardiac transplantation.<h4>Methods</h4>In this retrospective study we investigated patients who were treated with PCSK9 inhibitors either because of intolerance of statins or residual hypercholesterolaemia with evidence of cardiac allograft vasculopathy. We compared the data of patients prior to the start with these medications with their most recent dataset.<h4>Results</h4>Ten patients (nine men; mean age 58±6 years) underwent cardiac transplantation 8.3±4.5 (range 3-15) years ago. The treatment duration of Evolocumab or Alirocumab was on average 296±125 days and lead to a reduction of total Cholesterol (281±52 mg/dl to 197±36 mg/dl; p = 0.002) and LDL Cholesterol (170±22 mg/dl to 101±39 mg/dl; p = 0.001). No significant effects on HDL Cholesterol, BNP, Creatin Kinase or hepatic enzymes were noticed. There were no unplanned hospitalisations, episodes of rejections, change of ejection fraction or opportunistic infections. Both patients on Alirocumab developed liver pathologies: One patient died of hepatocellular carcinoma and the other developed hepatitis E.<h4>Conclusions</h4>Our study demonstrates that the PCSK9 inhibitors Evolocumab and Alirocumab lead to a significant reduction of LDL Cholesterol in heart transplantation recipients. No effect on cardiac function or episodes of rejections were noticed. Larger and long-term studies are needed to establish safety and efficacy of PCSK9 inhibitors after cardiac transplantation.
url https://doi.org/10.1371/journal.pone.0210373
work_keys_str_mv AT michaelkuhl treatmentofhypercholesterolaemiawithpcsk9inhibitorsinpatientsaftercardiactransplantation
AT christianbinner treatmentofhypercholesterolaemiawithpcsk9inhibitorsinpatientsaftercardiactransplantation
AT joannajozwiak treatmentofhypercholesterolaemiawithpcsk9inhibitorsinpatientsaftercardiactransplantation
AT juliafischer treatmentofhypercholesterolaemiawithpcsk9inhibitorsinpatientsaftercardiactransplantation
AT jochenhahn treatmentofhypercholesterolaemiawithpcsk9inhibitorsinpatientsaftercardiactransplantation
AT alaeldinaddas treatmentofhypercholesterolaemiawithpcsk9inhibitorsinpatientsaftercardiactransplantation
AT borisdinov treatmentofhypercholesterolaemiawithpcsk9inhibitorsinpatientsaftercardiactransplantation
AT jensgarbade treatmentofhypercholesterolaemiawithpcsk9inhibitorsinpatientsaftercardiactransplantation
AT gerhardhindricks treatmentofhypercholesterolaemiawithpcsk9inhibitorsinpatientsaftercardiactransplantation
AT michaelborger treatmentofhypercholesterolaemiawithpcsk9inhibitorsinpatientsaftercardiactransplantation
_version_ 1714805206275850240