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Cardiovascular disease from atherosclerosis remains a major cause of death in Australia. Epidemiological studies have demonstrated that reducing low-density lipoprotein cholesterol (LDL-C) strongly correlates with improved cardiovascular risk in. Although statin based therapy remains our most effective and first line therapy, certain cohorts remain refractory to their benefits. Proprotein convertase subtilisin/kexin type 9 (PCSK9), a monoclonal antibody, is currently under research as a novel non-statin based therapy in multiple clinical trials. PCSK9 targets low-density lipoprotein receptors for internalisation and lysomal degradation. This affects cholesterol homeostasis by reducing the cells ability to internalise circulating apoliprotein B. Early trials have shown clear benefits in LDL-C reduction without major adverse incidence in populations intolerant to statins, those with familial hypercholesterolaemia and patients requiring additional treatment to meet cholesterol targets despite statin based therapy. This article is a clinical focus reviewing the current phase I, II and III trials being conducted and the potential benefits a monoclonal antibody to PCSK9 may hold for cholesterol regulation in the future.
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