Authors

• Waleed AlHabeeb, Department of Cardiac Sciences, King Saud University, Riyadh, Saudi Arabia.Follow
• Hussein Alamri, Department of Cardiology, Prince Sultan Cardiac Centre, Riyadh, Saudi Arabia
• Hussein Elbadawi, Metabolic Unit, My Clinic International, Jeddah, Saudi Arabia.
• Yazed S. AlRuthia, Pharmacoeconomics Research Unit, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.
• Waleed Alharbi, King Fahad Cardiac Center, King Saud University Medical City, Department of Cardiac Sciences, College of Medicine, King Saud University Riyadh, Saudi Arabia.
• Owayed Alshammeri, Department of Cardiology, Dr Sulaiman Alhabib - Al Rayyan Hospital, Riyadh, Saudi Arabia
• Adel Tash, Department of Cardiac Surgery, National Heart Center, Riyadh, Saudi Arabia.
• Shadi Almoziny, Medical Department, Council of Health Insurance, Riyadh, Saudi Arabia.
• Naji Kholaif, Heart Center of excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
• Hussain Halawani, Department of Health Governance, Tawuniya, Riyadh, Saudi Arabia.
• Fadia AlMahdi, Department of Pharmaceutical Governance and Benefit Management, Bupa Arabia, Jeddah, Saudi Arabia
• Wael Yar, Medical Department, Council of Health Insurance, Riyadh, Saudi Arabia
• Khalid F Alhabib, Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia

Advancing Lipid Management: Saudi Heart Association Position Statement on PCSK9-Targeted Therapies in the Primary and Secondary Prevention of Cardiovascular Disease

Abstract

Background: Despite robust evidence for low-density lipoprotein cholesterol (LDL-C) reduction in atherosclerotic cardiovascular disease (ASCVD) prevention, attainment of guideline-recommended targets remains suboptimal in Saudi Arabia, especially among high- and very high-risk patients. Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9)-targeted therapies, which include monoclonal antibodies (evolocumab, alirocumab) and small interfering RNA (inclisiran), offer potent LDL-C lowering that can help address this gap.

Methods: The Saudi Heart Association (SHA) convened a multidisciplinary panel to review evidence from randomized controlled trials, real-world studies, and economic analyses on PCSK9-targeted therapies. Recommendations were developed through expert consensus, contextualized to the Saudi healthcare environment.

Results and conclusions: PCSK9 inhibitors (evolocumab, alirocumab) lower LDL-C substantially by around 60% and reduce the risk of adverse cardiovascular outcomes when added to maximally tolerated statins. Inclisiran achieves similar LDL-C reductions with biannual dosing, potentially improving adherence, though cardiovascular outcome data are pending. Both drug classes are well tolerated across diverse patient populations, including those with high or very high-risk, familial hypercholesterolemia (FH), recent acute coronary syndrome (ACS), or statin intolerance. The SHA expert panel recommends the early integration of upfront combination treatment including PCSK9-targeted therapies for patients with high risk features unlikely to reach LDL-C goals with statins ± ezetimibe, including recent ACS, FH, established ASCVD, metabolic conditions with end-organ damage, and statin intolerance. For Saudi populations, targeted integration of these agents into combination regimens offers a significant opportunity to close LDL-C treatment gaps and reduce residual ASCVD risk.

Recommended Citation

AlHabeeb, Waleed; Alamri, Hussein; Elbadawi, Hussein; AlRuthia, Yazed S.; Alharbi, Waleed; Alshammeri, Owayed; Tash, Adel; Almoziny, Shadi; Kholaif, Naji; Halawani, Hussain; AlMahdi, Fadia; Yar, Wael; and Alhabib, Khalid F (2026) "Advancing Lipid Management: Saudi Heart Association Position Statement on PCSK9-Targeted Therapies in the Primary and Secondary Prevention of Cardiovascular Disease," Journal of the Saudi Heart Association: Vol. 38 : Iss. 1 , Article 16.
Available at: https://doi.org/10.37616/2212-5043.1488

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