Female patient 62 years old
Cardiovascular risk factors: Arterial hypertension, smoking, obesity, dyslipidemia, hypercholesterolemia, family history of cardiovascular diseases (father who died from miocardial infarction (MI) and brother with 3 MI).
Intolerance to various statins (myalgia)
Non-critical atherosclerosis of the supra-aortic trunks.
Therapy with PCSK9 inib. started. (evolocumab 140 mg every 2 weeks).
Subsequently the patient suffers from acute coronary syndrome (NSTEMI). CACG: fusiform aneurysm of proximal left anterior descending artery (LAD)
The new LDL target to be reached < 55 mg/dl is far from the value achieved with the co-administration of PCSK9 inib. and ezetimibe (minimum LDL value reached with this therapy 123 mg/dl) Even with a certain time delay it was decided to introduce a statin at an extremely low dose (rosuvastatin 5 mg 3 times a week). The effect of this strategy is very effective, allowing a reduction in LDL by over 50% and up to a value of 60 (only slightly higher than the target value). However, the patient again suffers from myalgia (without an increase in CPK) and decides to suspend treatment with a new increase in LDL values to 112 mg/dl. The case emphasizes: 1) the synergistic effect of statin with PCSK9 inhibitor therapy. This synergy is already evident with extremely low doses of statin and should always be sought 2) the usefulness of an aggressive drug therapy that tends to bring LDL values within the therapeutic targets in the shortest possible time. Moreover this could highlight intolerances that make it impossible to continue with a specific therapeutic scheme so as to allow the study of new options.
