Expert Opinion on the Use of Inclisiran in Post-Acute Coronary Syndrome Patients in Indonesia

Abstract

Elevated low-density lipoprotein cholesterol (LDL-C) levels are an independent risk factor for the progression of atherosclerotic cardiovascular disease (ASCVD). Achieving substantial LDL-C reduction is recognized as a primary therapeutic goal, particularly for those at the highest risk of future cardiovascular events. Statin-based lipid-lowering therapy remains the cornerstone of secondary prevention in acute coronary syndrome (ACS). However, many high-risk individuals require combination therapy with non-statin agents to achieve guideline-recommended LDL-C targets. A novel, long-acting small interfering RNA (siRNA)-based proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor, inclisiran, has emerged as a therapy that provides rapid and sustained LDL-C reduction. Despite these therapeutic advancements, various hurdles continue to hinder optimal lipid management in Indonesia. To address these challenges, an expert meeting involving cardiologists from multiple cities across Indonesia was convened, and the resulting consensus opinion of experts aimed to provide insights into the current hurdles in managing post-ACS and the potential use of inclisiran following high intensity statin or highest tolerated dose statins, with or without ezetimibe, in post-ACS patients in Indonesia.