Recent Advances on the Roles of PCSK-9 Inhibitors in the Management of Acute Ischemic Stroke Patients

• Published in: International journal of molecular sciences Vol. 23; no. 18; p. 10221
• Main Authors: Ilut, Silvina, Pirlog, Bianca O, Pirlog, Radu, Nutu, Andreea, Vacaras, Vitalie, Armean, Sebastian M
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 06.09.2022; MDPI
• Subjects: acute ischemic stroke; Anticholesteremic Agents - adverse effects; Atherosclerosis; Bacteriocins; Cardiology; Cardiovascular disease; Cholesterol; Cholesterol, LDL - metabolism; Complex formation; Disease prevention; Drug dosages; Enzymes; FDA approval; Guidelines; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - pharmacology; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; hyperlipemia; Hyperlipidemias - drug therapy; hypolipemic treatment; Ischemia; Ischemic Stroke - drug therapy; Kexin; Liver; Low density lipoprotein; Metabolic pathways; Patients; PCSK-9; prevention; Proprotein Convertases; Protein turnover; Proteins; Review; Risk analysis; Risk factors; Statins; Stroke; Stroke - chemically induced; Stroke - drug therapy; Europe; hypolipemic treatment; hyperlipemia; PCSK-9; acute ischemic stroke; statins; prevention
• ISSN: 1422-0067; 1661-6596; 1422-0067
• DOI: 10.3390/ijms231810221

Acute ischemic stroke (AIS) represents an important cause of disability and death. Since only a minor percentage of patients with AIS are eligible for acute therapy, the management of risk factors is mandatory. An important risk factor of AIS is hyperlipemia. The current guidelines recommend a strict correction of it. Statins are recommended as the first-line treatment, while proprotein convertase subtilin/kexin type 9 (PCSK-9) inhibitors are administered as a second or even third option when the goal for a low-density lipoprotein cholesterol (LDL-C) level is not achieved. PCSK-9 inhibitors effectively decrease the LDL-C levels through the inhibition of PCSK-9-LDL-receptor complex formation. The in-depth understanding of the PCSK-9 protein mechanism in the metabolism of LDL-C led to the development of effective targeted approaches. Furthermore, a better understanding of the LDL-C metabolic pathway led to the development of newer approaches, which increased the therapeutic options. This article aims to offer an overview of the PCSK-9 inhibitors and their mechanism in reducing the LDL-C levels. Moreover, we will present the main indications of the current guidelines for patients with hyperlipemia and for those who have suffered an acute ischemic stroke, as well as the importance of LDL-C reduction in decreasing the rate of a recurrence.