Adherence to proprotein convertase subtilisin/kexin 9 inhibitors in high cardiovascular risk patients: an Italian single-center experience
In clinical practice, there is an unmet need for adherence to lipid-lowering therapy. Despite established international guidelines,1 contemporary studies report poor adherence to statins in a substantial proportion of high-risk patients, associated with worse cardiovascular outcome.2,3 On the contrary, even if alternative strategies feasible for reducing primary nonadherence have been proposed,4 interventions able to improve adherence are complex and difficult to sustain in outpatients.5 Proprotein convertase subtilisin/kexin 9 inhibitors (PCSK9i) have recently proved effective in reducing coronary plaque progression,6 LDL cholesterol (LDL-C), and cardiovascular events in high-risk patients.7 Considering their convenient administration regimen (bi-weekly or monthly) and favorable adverse-effects profile reported in clinical trials,7 with no risk of new-onset diabetes8 or cognitive deficits,9 PCSK9i may be expected to demonstrate high adherence levels and low discontinuation rate, especially in patients with high pill burden. Initial data reporting high overall adherence to PCSK9i from clinical trials10 and United States clinical practice have been reported.11 No data deriving from European practice are currently available in the literature. This study aimed to investigate adherence to PCSK9i in comparison with statins in high-risk cardiovascular patients in an Italian cardiology center.