Letter by Koh Regarding Article, “Pleiotropic Effects of PCSK9 (Proprotein Convertase Subtilisin/Kexin Type 9) Inhibitors?”
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To the Editor:
In her recent article, Bittner discussed pleiotropic effects of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors.1 PCSK9 is a serine protease that is secreted by the liver, binds to the low-density lipoprotein (LDL) receptor, and directs the LDL receptor toward lysosomal degradation. PCSK9 inhibitors achieve LDL-cholesterol (LDL-C) reductions of 45% to 60% and similarly LDL particle number, small and large LDL particles, and apolipoprotein B levels. The impact of PCSK9 inhibition is not limited to reduction in LDL-C but also affects other aspects of lipoprotein metabolism, inflammation, thrombosis, and immune function. PCSK9 inhibitors lower lipoprotein (a) by as much as 30% …