Day 2 Coverage: Saturday, August 12

Last Updated: Tuesday, 15-Aug-2017 15:45:00 EDT
Debate – PCSK9 in Primary Prevention

John R. Guyton, MD, FNLA

Professor of Medicine
Assistant Professor of Pathology
Department of Medicine
Duke University School of Medicine
Durham, NC
Diplomate, American Board of Clinical Lipidology




Sergio Fazio, MD, PhD, FNLA

Professor of Medicine Director of Preventive Cardiology
Oregon Health and Science University Portland, OR
Diplomate, American Board of Clinical Lipidology




The audience was treated to different viewpoints on the use of PCSK9 inhibitors in primary prevention. John R. Guyton, MD, FNLA, presented the “yes” point of view.

Dr. Guyton’s key points included:

  • PCSK9 inhibitor prescriptions should be extended to patients with a baseline LDLC ≥ 190 mg/dl, inadequate LDLC lowering and evidence of severe subclinical atherosclerosis such as CT coronary calcium score (such as >600) or high grade, progressive carotid plaques.
  • The FOURIER trial results have provided reassuring evidence of efficacy and short-term (1-3 year) safety.

Sergio Fazio, MD, PhD, FNLA, presented the “no” point of view.

Dr. Fazio’s key points included:

  • Though new PCSK9 agents reduce LDL by 50-65%, the cost to the patient is up to $15,000 per year.
  • Results from the FOURIER trial support moderate efficacy in secondary prevention, but no cost-effectiveness analyses are available yet, and none for primary prevention.
  • Prescriptions thus far are covering a tiny fraction of patients with indications, due to the adversarial stance of health insurances, less-than-enthusiastic endorsement by providers, and cautious acceptance by patients.