- Global Pharma News & Resources

New survey reveals key barriers limiting cardiologist prescribing of PCSK9 inhibitors

New survey reveals key barriers limiting cardiologist prescribing of PCSK9 inhibitors

  • Uptake of proprotein convertase subtilisin/kexin type-9 inhibitors (PCSK9is) for the treatment of primary hypercholesterolaemia and mixed lipidaemia has been slower than expected
  • An online survey, commissioned by Sanofi, included 100 UK cardiologists and revealed perceived key issues in the PCSK9is adoption pathway[1]

READING, UK – 3rd February 2020 – Results from a new Sanofi survey found that despite 97% of cardiologists stating they are satisfied with their ability to reach patient lipid treatment goals with PCSK9is, only 6% are currently prescribing them.[1] PCSK9is lower LDL cholesterol levels and are used to treat primary hypercholesterolemia and mixed lipidaemia.[2] Primary hypercholesterolaemia affects about 4% of the adult population, totalling over 1.5 million people in England.[3] In the survey, low prescribing of PCSK9is was attributed to infrequent lipid testing, balancing interest in a multitude of disease management factors, and lack of clarity regarding responsibility of cholesterol management between interventional and non-interventional cardiologists and lipid specialists.[1]

The low uptake findings are in line with the National Institute for Health and Care Excellence (NICE) innovation scorecard which highlights that uptake of PCSK9is was 77% lower than expected between January 2018 and December 2018, equating to around 8,880 eligible patients not receiving PCSK9i that year.[4]

PCSK9is were recommended by NICE in 2016 as a treatment option for patients with cardiovascular disease treated with maximally tolerated lipid-lowering therapies. PCSK9is are only recommended if low-density lipoprotein cholesterol (LDL-C) concentration is persistently above 4.0 mmol/l.[2],[5] Last year PCSK9is were fast-tracked by the Accelerated Access Collaborative (AAC) for rapid uptake in England.[6]

The survey revealed the following key barriers cardiologists believe are limiting their prescribing of PCSK9is:[1]

  • Infrequent lipid testing

Over half (58%) of cardiologists surveyed believe that patients should be given lipid tests at least once every three months, yet three quarters (75%) acknowledge that it currently happens less frequently than this.

  • Lower interest in cholesterol management compared to acute cardiovascular events

When asked to rate treatment goals by interest, 77% of cardiologists surveyed said they were more interested in managing acute cardiovascular events compared to managing elevated LDL-C levels.[1] Management of acute cardiovascular events at admission was rated of greatest interest.

  • No clear treatment ‘manager’

Throughout the patient journey, healthcare professionals have varying beliefs on who is responsible for lipid management: for instance, 63% believe interventional cardiologists have primary responsibility at admission; 37% stated that non-interventional cardiologists have primary responsibility at follow-up; and 56% said the GP has primary responsibility for the ongoing management. The survey revealed that 59% of cardiologists surveyed believed the responsibility for prescribing PCSK9is sat with lipid specialists rather than cardiologists.

Professor Zaman, Professor of Cardiology at Newcastle Hospital, comments: “The results of this survey are interesting and confirm that despite the overwhelming majority of cardiologists believing PCSK9is may provide benefits for eligible patients, there are barriers preventing them prescribing. Through increasing the frequency of lipid testing, raising the priority of cholesterol management as a treatment goal and establishing clear responsibilities among the multidisciplinary team, we can make steps to improving the management of high cholesterol.”




About PCSK9is

PCSK9is were recommended by NICE in 2016 for patients treated with maximally tolerated lipid-lowering therapies, but who still require additional treatment to lower LDL-C to recommended goals.[2],[5]

Low-density lipoprotein cholesterol concentrations[2]


Without CVD

With CVD



High risk of CVD[1]

Very high risk of


Primary non-familial


or mixed dyslipidaemia

Not recommended at any LDL-C concentration

Recommended only if LDL-C concentration

is persistently above 4.0 mmol/l

Recommended only if LDL-C concentration

is persistently above 3.5 mmol/l




Recommended only if LDL-C concentration is persistently above 5.0 mmol/l

Recommended only if LDL-C concentration is persistently above 3.5 mmol/l

[1]High risk of cardiovascular disease is defined as a history of any of the following: acute coronary syndrome (such as myocardial infarction or unstable angina requiring

hospitalisation), coronary or other arterial revascularisation procedures, coronary heart disease, ischaemic stroke, peripheral arterial disease.

[2]Very high risk of cardiovascular disease is defined as recurrent cardiovascular events or cardiovascular events in more than 1 vascular bed (that is, polyvascular disease).

Abbreviations: CVD, cardiovascular disease; LDL-C, low-density lipoprotein cholesterol.


PCSK9is act on the PCSK9 protein, made in the liver.[7] Liver cells have low-density lipoprotein (LDL) receptors on the outside of them, which attach to LDL cholesterol when it passes by in the blood.[8] LDL cholesterol is considered the “bad” cholesterol, because it contributes to fatty build ups in arteries (atherosclerosis). [8] Atherosclerosis narrows the arteries and increases the risk of heart attack and stroke.[8] The LDL receptor takes the LDL cholesterol out of the blood and into the liver to be broken down.[7] The more LDL receptors a person has, the easier it is for them to keep their blood cholesterol low.[7]

The PCSK9 protein breaks down the LDL receptors, so that there is less of them – meaning cholesterol goes up.[7] PCSK9is stop this protein from working, so that there are more LDL receptors, and less cholesterol in the blood.[7]


About the AAC

The AAC was set up in 2018 to speed up patient access to ground-breaking medicines.[9] The AAC brings industry, government and the NHS together to remove barriers to uptake of innovations, so that NHS patients have faster access to innovations that can transform care.[10] It is hosted by the National Health Service (NHS) England and NHS Improvement, and aims to:[11]

  • Drive the uptake and adoption of innovation in the NHS
  • Identify and support innovations that will deliver the most benefits for patients
  • Streamline existing activities for high potential, innovative products
  • Develop new and different ways of working to speed up processes.


About the survey

This survey was commissioned by Sanofi and conducted by Healthcare Research Worldwide (HRW). 100 cardiology consultants and 20 specialist cardiology registrars from across the UK completed an online questionnaire between 1st and 22nd July 2019.


 About Sanofi

Sanofi is dedicated to supporting people through their health challenges. We are a global biopharmaceutical company focused on human health. We prevent illness with vaccines, provide innovative treatments to fight pain and ease suffering. We stand by the few who suffer from rare diseases and the millions with long-term chronic conditions.

With more than 100,000 people in 100 countries, Sanofi is transforming scientific innovation into healthcare solutions around the globe.

Sanofi, Empowering Life



Media Relations Contact
Claire Whitmarsh
Tel.: +44 7935 503 416




Job bag number: SAGB.ALI.19.09.1645           Date of preparation: January 2020



[1] H4219 Primary hypercholesterolemia and mixed dyslipidaemia treatment and management survey. August 2019

[2] NICE. Alirocumab for treating primary hypercholesterolaemia and mixed dyslipidaemia. Last accessed January 2020.

[3] NICE. Alirocumab for treating primary hypercholesterolaemia and mixed dyslipidaemia HTA Scope. August 2015. Last accessed January 2020. Available at:

[4] NHS Digital. NICE Innovation Scorecard to December 2018. Last accessed January 2020 Available at: Last accessed December 2019

[5] NICE. Evolocumab for treating primary hypercholesterolaemia and mixed dyslipidaemia. Last accessed January 2020.

[6] NICE. AAC Rapid Uptake Products. Last accessed January 2020.

[7] Heart UK. PCSK9 inhibitors. last accessed December 2019

[8] American Heart Association. HDL (Good), LDL (Bad) Cholesterol and Triglycerides. Last accessed January 2020.

[9] NHS patients to get faster access to pioneering treatments. Last accessed January 2020.

[10] NHS. The Accelerated Access Collaborative. Available at: Last accessed January 2020.

[11] NICE. About the Accelerated Access Collaborative. Last accessed January 2020.


Editor Details

Last Updated: 06-Feb-2020