As cases of acute myocardial infarction (AMI) steadily increase in Korea, PCSK9 inhibitors are emerging as a promising solution for high-risk 토토 사이트 바카라 who fail to achieve LDL-C (low-density lipoprotein cholesterol) targets with statins and ezetimibe.

According to updated data from the Health Insurance Review and Assessment Service (HIRA), 142,746 AMI patients (ICD code I21) were registered in 2023—marking a 74% rise from 81,824 cases in 2014. Alarmingly, recurrence rates are rising even faster. The Korea Disease Control and Prevention Agency reported in December that the recurrence rate of myocardial infarction more than doubled over the past decade, reaching 6.6 cases per 100,000 people in 2022—outpacing the 44% increase in initial cases.

This trend is particularly concerning, as recurrent atherosclerotic cardiovascular disease (ASCVD) events, including heart attacks, are associated with significantly higher mortality. One in three patients who have experienced a heart attack or stroke is likely to suffer another event. Mortality rates for recurrent myocardial infarction are 2–3 times higher than first-time cases, ranging from 68% to 85%.

In response, treatment guidelines in Korea have been updated to emphasize more aggressive LDL-C lowering. The Korean Society of Cardiology’s Acute Coronary Syndrome (ACS) Research Group revised its guidelines in December 2024, recommending that ACS patients lower LDL-C to below 55 mg/dL and achieve at least a 50% reduction from baseline. Similarly, the Korean Society of Lipid and Atherosclerosis now advises these same targets for coronary artery disease patients, aligning with global recommendations.

However, real-world data indicate that many high-risk patients still fail to meet these targets. A study published in February by Professors Young-Hak Kim and Aram Kim at Asan Medical Center analyzed 16,934 high-risk ASCVD patients. Only 33.7% achieved LDL-C levels below 55 mg/dL within 4–12 weeks after hospital discharge.

Crucially, those who reached target LDL-C levels within 3 months experienced an 11% lower risk of major adverse cardiovascular events (MACE) (adjusted hazard ratio [aHR]: 0.89, 95% CI: 0.82–0.96). Among ACS patients, the risk reduction was even greater at 27% (aHR: 0.73, 95% CI: 0.63–0.85).

“These findings highlight how early achievement of LDL-C targets is key to reducing cardiovascular risk,” said Professor Chul-Min Ahn of Severance Cardiovascular Hospital. “The updated guidelines clearly recommend that very high-risk patients—such as those with prior myocardial infarction—reduce LDL-C below 55 mg/dL and achieve over a 50% reduction from baseline.”

Professor Ahn stressed that PCSK9 inhibitors offer an effective second-line therapy for 토토 사이트 바카라 who do not meet LDL-C goals with the standard combination of statins and ezetimibe.

Currently, three PCSK9 inhibitors are approved in Korea: Repatha (evolocumab, Amgen Korea), Praluent (alirocumab, Sanofi-Aventis), and Leqvio (inclisiran, Novartis Korea).

Repatha and Praluent are monoclonal antibodies, while Leqvio is a small interfering RNA (siRNA)-based therapy. All three have shown substantial LDL-C reductions in phase 3 clinical trials.

In the FOURIER trial, Repatha reduced LDL-C by about 60% to a median of 30 mg/dL at 48 weeks. It also significantly lowered the risks of myocardial infarction (–27%), stroke (–21%), and coronary revascularization (–22%) compared to placebo. Rapid LDL-C reduction was seen from Day 1, and consistent lowering was observed in a subgroup of 181 Korean patients. Repatha also boasts the longest median follow-up data—8.6 years—supporting long-term safety and tolerability.

Praluent, evaluated in the ODYSSEY OUTCOMES trial, demonstrated a 15% reduction in MACE over 2.8 years in 토토 사이트 바카라 with ACS, including myocardial infarction and unstable angina. It achieved an average LDL-C reduction of 54.7%, peaking at Week 4.

Leqvio, tested in the ORION-9, -10, and -11 trials, recorded LDL-C reductions of 47.9%, 52.3%, and 49.9%, respectively, at Day 510. In ORION-18, which included 24% Korean participants, Leqvio achieved a 57.17% reduction by Day 330.

“For patients not achieving LDL-C targets with maximum statin and ezetimibe therapy, PCSK9 inhibitors should be strongly considered,” Professor Ahn advised. “It is important that patients work with their healthcare providers to set and actively manage their LDL-C goals.”

In Korea, Repatha and Praluent are currently approved and reimbursed for secondary prevention in ASCVD 토토 사이트 바카라. Internationally, the American College of Cardiology (ACC) recommends monoclonal antibody-based PCSK9 inhibitors as initial treatment options, based on consistent safety and efficacy data from the FOURIER and ODYSSEY trials.