Inhibitors in the Management of Patients with Atherosclerotic Cardiovascular Diseases: Guidelines and Reimbursement Issues
Abstract
Current guidelines for the management of patients with dyslipidemia define low-density lipoprotein cholesterol (LDL-C) as the primary target in addressing lipid-lowering therapy. The target level of LDL-C in real clinical practice is achieved in no more than a third of patients who have undergone a coronary event and receive high-intensity lipid-lowering therapy. Achieving the goals of lipid-lowering therapy in a significant proportion of patients with atherosclerotic cardiovascular diseases (ACVD) is impossible with the use of even high doses of statins, which requires its enhancement by other drugs. The article considers the place of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors in the prevention of cardiovascular diseases in patients with ACVD in accordance with the latest Russian and international guidelines. A modern decision-making algorithm for the initiation of PCSK9 inhibitors therapy in patients with ACVD is presented. The authors provide a clear understanding about the patient populations that will benefit most from the taking of PCSK9 inhibitors. Particular attention is paid to Guidelines for the management of dyslipidemias developed by European Society of Cardiology and European Atherosclerosis Society in 2019. The issues of patients provision with PCSK9 inhibitors with reference to Russian conditions are described in details in accordance with the requirements for territorial programs of state guarantees. Further improvement in the provision of PCSK9 inhibitors to patients with indications for this therapy is necessary, considering the potential of these drugs in reducing cardiovascular morbidity and mortality in patients with ACVD.
About the Authors
M. V. Zhuravleva
Scientific Center for Expert Evaluation of Medicinal Products;
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Russian Federation
Marina V. Zhuravleva – MD, PhD, Professor, Deputy Director, Center for Clinical Pharmacology, Scientific Center for Expert Evaluation of Medicinal Products; Professor, Chair of Clinical Pharmacology and Propedeutics of Internal Diseases, Sechenov University
Petrovskii bulv. 8-2, Moscow, 127051,
Trubetskaya ul. 8-2, Moscow, 119991
A. B. Prokofiev
Scientific Center for Expert Evaluation of Medicinal Products;
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Russian Federation
Alexey B. Prokofiev – MD, PhD, Director, Center for Clinical Pharmacology, Scientific Center for Expert Evaluation of Medicinal Products; Professor, Chair of Clinical Pharmacology and Propedeutics of Internal Diseases, Sechenov University
Petrovskii bulv. 8-2, Moscow, 127051,
Trubetskaya ul. 8-2, Moscow, 119991
E. V. Shikh
Scientific Center for Expert Evaluation of Medicinal Products;
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Russian Federation
Evgenia V. Shikh – MD, PhD, Professor, Head of Chair of Clinical Pharmacology and Propaedeutics of Internal Medicine, Director of Institute of Professional Education, Sechenov University
Petrovskii bulv. 8-2, Moscow, 127051,
Trubetskaya ul. 8-2, Moscow, 119991
S. Yu. Serebrova
Scientific Center for Expert Evaluation of Medicinal Products;
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Russian Federation
Svetlana Yu. Serebrova – MD, PhD, Chief Researcher, Scientific Center for Expert Evaluation of Medicinal Products; Professor, Chair of Clinical Pharmacology and Propedeutics of Internal Diseases, Sechenov University
Petrovskii bulv. 8-2, Moscow, 127051,
Trubetskaya ul. 8-2, Moscow, 119991
G. I. Gorodetskaya
Scientific Center for Expert Evaluation of Medicinal Products;
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Russian Federation
Galina I. Gorodetskaya – MD, PhD, Leading Analyst, Scientific Center for Expert Evaluation of Medicinal Products; Assistant, Chair of Clinical Pharmacology and Propaedeutics of Internal Medicine, Sechenov University
Petrovskii bulv. 8-2, Moscow, 127051,
Trubetskaya ul. 8-2, Moscow, 119991
E. Yu. Demchenkova
Scientific Center for Expert Evaluation of Medicinal Products;
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Russian Federation
Elena Yu. Demchenkova – PhD (Pharmacology), Senior Analyst, Scientific Center for Expert Evaluation of Medicinal Products; Senior Assistant, Chair of Clinical Pharmacology and Propaedeutics of Internal Medicine, Sechenov University
Petrovskii bulv. 8-2, Moscow, 127051,
Trubetskaya ul. 8-2, Moscow, 119991
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Review
For citations:
Zhuravleva M.V., Prokofiev A.B., Shikh E.V., Serebrova S.Yu., Gorodetskaya G.I., Demchenkova E.Yu. Inhibitors in the Management of Patients with Atherosclerotic Cardiovascular Diseases: Guidelines and Reimbursement Issues. Rational Pharmacotherapy in Cardiology. 2020;16(4):644-653. (In Russ.) https://doi.org/10.20996/1819-6446-2020-08-21
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