OBJECTIVES

: Current ESC/EAS guidance recommends considering multiple factors when determining eligibility for PCSK9 inhibitors. This study aimed to identify factors that influence prescribing of PCSK9 inhibitors among European cardiologists.

METHODS

: A questionnaire was sent to 11 cardiologists with experience of prescribing PCSK9 inhibitors in 7 European countries. Clinicians were asked which factors they considered when prescribing PCSK9 inhibitors. To explore combinations of factors, 9 hypothetical patient profiles were developed, reflecting patients for whom PCSK9 inhibitors would or would not be recommended by clinical guidelines.

RESULTS

: All respondents indicated that the factors considered were cardiovascular (CV) event history, genetic factors (primarily familial hypercholesterolemia [FH] status), and low-density lipoprotein cholesterol (LDL-C) levels. Other factors included treatment history, age/life expectancy, and comorbidities (e.g., diabetes). When considering PCSK9 inhibitors for patients with very high CV risk, CV event history (e.g., myocardial infarction, stroke), LDL-C levels, and treatment history were rated as extremely important by 64–82% of respondents. Other risk factors, including comorbidities and patient characteristics (e.g., age, sex), were considered less important. The majority of respondents (64%) reported that LDL-C thresholds (100–140 mg/dL) in the 2016 ESC/EAS consensus statement aligned with the levels used in their practice to determine appropriate use for patients without FH. Considering hypothetical patient profiles, the majority of respondents (54% for each profile) considered 3 profiles appropriate for treatment with a PCSK9 inhibitor. Common characteristics of patients considered eligible included previous myocardial infarction, comorbidities (angina or diabetes), treatment with high-intensity/maximally tolerated statins, and LDL-C levels 105–145 mg/dL; 2 profiles included peripheral arterial disease.

CONCLUSIONS

: The decision to initiate PCSK9 inhibitors depends on a combination of factors. Although generalizability is limited by the number of respondents (and that all cardiologists), the findings indicate that certain clinical factors, including CV event history, treatment history, and LDL-C level, are particularly important.