Non-Lipid Effects of PCSK9 Monoclonal Antibodies on Vessel Wall

Elevated low density lipoprotein (LDL) cholesterol and lipoprotein(a) (Lp(a)) levels have an important role in the development and progression of atherosclerosis, followed by cardiovascular events. Besides statins and other lipid-modifying drugs, PCSK9 monoclonal antibodies are known to reduce hyperlipidemia. PCSK9 monoclonal antibodies decrease LDL cholesterol levels through inducing the upregulation of the LDL receptors and moderately decrease Lp(a) levels. In addition, PCSK9 monoclonal antibodies have shown non-lipid effects. PCSK9 monoclonal antibodies reduce platelet aggregation and activation, and increase platelet responsiveness to acetylsalicylic acid. Evolocumab as well as alirocumab decrease an incidence of venous thromboembolism, which is associated with the decrease of Lp(a) values. Besides interweaving in haemostasis, PCSK9 monoclonal antibodies play an important role in reducing the inflammation and improving the endothelial function. The aim of this review is to present the mechanisms of PCSK9 monoclonal antibodies on the aforementioned risk factors.

Automated summary

PCSK9 monoclonal antibodies reduce LDL cholesterol levels and moderately decrease Lp(a) levels by upregulating LDL receptors. They also have the ability to decrease platelet aggregation and activation, increase platelet responsiveness to acetylsalicylic acid, decrease the incidence of venous thromboembolism, and play a role in reducing inflammation and improving endothelial function.