BackgroundBy lowering LDL cholesterol (LDLC) ∼60% beyond statins, PCSK9s have the potential to profoundly improve primary and secondary prevention of atherosclerotic coronary artery (CAD), peripheral (PAD), and carotid artery disease.PurposeIn 189 patients referred to a regional Cholesterol Center for diagnosis and treatment of hypercholesterolemia, who had initial LDL cholesterol (LDLC) ≥130 but <160 mg/dl, our specific aim was to determine how many would be eligible for PCSK9 therapy by extant preferred commercial insurance criteria.MethodsCurrent preferred commercial insurance criterion for PCSK9 therapy consisted of ≥1 of the following 3 conditions:Heterozygous familial hypercholesterolemia (previous LDLC >190 mg/dl and Tendon Xanthomas),Atherosclerotic cerebral-cardio-peripheral vascular disease.Failure to tolerate 2 or more statins.ResultsAt entry, in the 189 patients, mean±SD and median LDLC were 144±9 mg/dl and 143 mg/dl respectively. Of the 189 patients (96 female and 93 male with median age 53) 16 (8%) were diagnosed as having heterozygous FH, with median LDLC of 139 mg/dl, and 32 (17%) had sustained a cerebral-cardio- peripheral vascular event with median LDLC on treatment of 146 mg/dl. Of the 189 patients, in 44 (23%) the maximum tolerated statin dose was zero (complete statin intolerant), with median LDLC of 145 mg/dl. Of the 44 statin intolerant patients, 18 (41%) had either HeFH or an atherosclerotic event, and 26 (59%) had neither positive. Altogether 73 of 189 (39% of patients with entry LDLC ≥130 but <160 were eligible for PCSK9 therapy from commercial carriers.ConclusionOf 189 patients referred to a regional Cholesterol diagnosis and treatment center with initial LDLC ≥130 but <160 mg/dl, 73 (39%) met current commercial insurance carrier preferred criteria for PCSK9 drug coverage.
Editorial: Novel Advances in Allergy Diagnosis and Treatment
