New possibilities for lipid level control using inclisiran — prospects for interaction between a cardiologist and a neurologist

Dyslipidemia is one of the most significant modifiable cardiovascular risk factors. The change in the modern paradigm for dyslipidemia treatment from high-intensity statin therapy to high-intensity lipid-lowering therapy makes it possible to more often use new drug classes to achieve the target level of low-density lipoprotein cholesterol. The article presents two case reports on the use of inclisiran as part of combination lipid-lowering therapy for secondary prevention in patients at very high cardiovascular risk. Based on the presented cases, following clinical aspects of the management of cardiovascular patients are discussed: the safety of achieving low-density lipoprotein cholesterol levels below 1 mmol/l in a patient with asymptomatic cerebral infarction, the need for adequate dyslipidemia treatment after revascularization, the strategic importance of prescribing lipid-lowering therapy in patients with cerebrovascular disease to reduce the cardiovascular risk, adherence to therapy as a significant aspect of effective dyslipidemia control.

1. Boytsov SA, Provatorov SI. Possibilities of dispensary observation in reducing mortality from coronary heart disease. Terapevticheskii Arkhiv. 2023;95(1):5-10 (In Russ.) DOI:10.26442/00403660.2023.01.202038.

2. Boytsov SA, Drapkina OM, Shlyakhto EV, et al. Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation (ESSE-RF) study. Ten years later. Cardiovascular Therapy and Prevention. 2021;20(5):3007 (In Russ.) DOI:10.15829/1728-8800-2021-3007.

3. Mach F, Baigent C, Catapano AL, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J. 2020;41(1):111-188. DOI:10.1093/eurheartj/ehz455.

4. Ezhov MV, Kukharchuk VV, Sergienko IV, et al.; ESC Scientific Document Group Disorders of lipid metabolism. Clinical Guidelines 2023. Russian Journal of Cardiology. 2023;28(5):5471 (In Russ.) DOI:10.15829/1560-4071-2023-5471.

5. Wang N, Tall AR. A New Approach to PCSK9 Therapeutics. Circ Res. 2017;120(7):1063-1065. DOI:10.1161/CIRCRESAHA.117.310610.

6. Katsiki N, Vrablik M, Banach M, et al. Inclisiran, Low-­Density Lipoprotein Cholesterol and Lipoprotein (a). Pharmaceuticals (Basel). 2023;16(4):577. DOI:10.3390/ph16040577.

7. Ray KK, Wright RS, Kallend D, et al. Two Phase 3 Trials of Inclisiran in Patients with Elevated LDL Cholesterol. N Engl J Med. 2020;382(16):1507-1519. DOI:10.1056/NEJMoa1912387.

8. Li M, Hou J, Gu X, et al. Incidence and risk factors of in-stent restenosis after percutaneous coronary intervention in patients from southern China. Eur J Med Res. 2022;27(1):12. DOI:10.1186/s40001-022-00640-z.

9. Cherepianskii MS, Ponomareva GM, Skiba IB, et al. Inclisiran in patients with acute ischemic stroke: first data. Kardiologiia. 2023;63(10):39-46 (In. Russ.) DOI:10.18087/cardio.2023.10.n2560.

10. Ray KK, Troquay RPT, Visseren FLJ, et al. Long-term efficacy and safety of inclisiran in patients with high cardiovascular risk and elevated LDL cholesterol (ORION-3): results from the 4-year open-label extension of the ORION-1 trial. Lancet Diabetes Endocrinol. 2023;11(2):109-119. DOI:10.1016/S2213-8587(22)00353-9.

11. Koenig W, Ray KK, Landmesser U, et al. Efficacy and safety of inclisiran in patients with cerebrovascular disease: ORION-9, ORION-10, and ORION-11. Am J Prev Cardiol. 2023;14:100503. DOI:10.1016/j.ajpc.2023.100503.

12. Fu JH, Mok V, Lam W, et al. Effects of statins on progression of subclinical brain infarct. Cerebrovasc Dis. 2010;30(1):51-6. DOI:10.1159/000313614.

13. Yanishevskiy SN, Skiba IB, Polushin AY. Statins in patients with acute ischemic stroke: when we should start therapy? “Arterial’naya Gipertenziya” (“Arterial Hypertension”). 2021;27(1):16-28 (In Russ.) DOI:10.18705/1607-419X-2021-27-1-16-28.

14. Voevoda MI, Gurevich VS, Ezhov MV, et al. Inclisiran — a new era in lipid-­lowering therapy. Kardiologiia. 2022;62(6):57-62 (In Russ.) DOI:10.18087/cardio.2022.6.n2115.