Best Science Medicine Podcast - BS without the BS
Jul 17, 2026 · 26 min · 12 segments
In episode 624, James and Mike K invite Tony Nickonchuk to go over all the new evidence we have for the PCSK9 inhibitors. First, we discuss whether or not the evidence addresses the issue of primary…
So what was the actual clinical question that we tried to answer there, Tony?
Yeah, I mean, the overall clinical question was, are PCSK9 inhibitors like Evalocumab and Alirocumab effective in preventing cardiovascular events?
Yeah, and where it gets very, very tricky is, are we talking primary care? Are we talking primary prevention? Are we talking secondary prevention? And how do you even define secondary prevention? All that sort of stuff.
So what we're going to do is talk about some of the more recent randomized control trials that came out and as best we can put them into context.
Maybe before Tony goes, when we did the simplified lipid guideline, we did not look at FH, familial hypercholesterolemia.
And we, we had kind of thought PSK9 inhibitors, the sphere was secondary prevention.
And Tony, you're going to go over a couple of those secondary prevention studies.
And in our risk calculator, if you clicked on PCSK9 inhibitors, it would say they have minimal evidence in primary prevention.
And then we said the risk reduction that we were presenting was from secondary prevention.
So what was the actual clinical question that we tried to answer there, Tony?
Yeah, I mean, the overall clinical question was, are PCSK9 inhibitors like Evalocumab and Alirocumab effective in preventing cardiovascular events?
Yeah, and where it gets very, very tricky is, are we talking primary care? Are we talking primary prevention? Are we talking secondary prevention? And how do you even define secondary prevention? All that sort of stuff.
So what we're going to do is talk about some of the more recent randomized control trials that came out and as best we can put them into context.
Maybe before Tony goes, when we did the simplified lipid guideline, we did not look at FH, familial hypercholesterolemia.
And we, we had kind of thought PSK9 inhibitors, the sphere was secondary prevention.
And Tony, you're going to go over a couple of those secondary prevention studies.
And in our risk calculator, if you clicked on PCSK9 inhibitors, it would say they have minimal evidence in primary prevention.
And then we said the risk reduction that we were presenting was from secondary prevention.
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