PCSK9 inhibition and type 2 diabetes
The focus of cardiovascular disease prevention has shifted from normalisation of risk factors to absolute risk reduction. Reducing low-density lipoprotein cholesterol (LDL-C) concentration by 1 mmol/L for around 5 years is consistently associated with a 23-25% lower risk of major cardiovascular events, for statin and non-statin therapies alike, regardless of the baseline LDL-C level.1 In high and middle income countries, statins are now routinely recommended as first line LDL-C-lowering therapy for people with 10 year modelled risk above somewhat arbitrary, country-specific thresholds defined by economic and clinical considerations. This high-risk category includes most patients with type 2 diabetes. Statins achieve similar reductions in relative risk among people with and without diabetes.2 However, even among patients on maximum doses, with LDL-C levels in the normal range, further reductions in LDL-C and modelled risk are possible.