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Vol. 31. Issue 2.
Pages 89-92 (March - April 2019)
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Vol. 31. Issue 2.
Pages 89-92 (March - April 2019)
Clinical report
DOI: 10.1016/j.artere.2019.02.004
Treatment of a high cardiovascular risk patient with McArdle's disease with PCSK9 inhibitors
Tratamiento de un varón con enfermedad de McArdle y muy alto riesgo cardiovascular con inhibidores de PCSK9
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Victoria Marco-Benedía,
Corresponding author
vmarcobenedi@gmail.com

Corresponding author.
, Estíbaliz Jarautaa,b, Sofía Pérez-Calahorraa, Ana M. Beaa, Fernando Civeiraa,b
a Clinical Lipid and Arteriosclerosis Research Unit, Hospital Universitario Miguel Servet, IIS (Instituto de Investigación Sanitaria [Health Research Institute]) Aragón, CIBERCV (Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares [Biomedical Research Centre for Cardiovascular Diseases]), Zaragoza, Spain
b Universidad de Zaragoza, Zaragoza, Spain
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Abstract

A 60-year-old male with familial combined hyperlipidemia, ischaemic heart disease and type 2 diabetes. Since childhood, intolerance to intense exercise. The patient was diagnosed of McArdle's disease after an episode of rhabdomyolysis associated with statins as treatment after a myocardial infarction. Since then, he had been treated with diet, fibrates and ezetimibe with good tolerance, despite this, LDL cholesterol (cLDL) remained >180mg/dl. He started to be treated with alirocumab 150mg/sc every 14 days, with excellent clinical response and a decrease in cLDL to 15mg/dl. Our case shows that PCSK9 inhibitors are effective and safe in patients with muscle diseases who have statin contraindication, and they are a good therapeutic tool for these patients.

Keywords:
McArdle's disease
Rhabdomyolysis
Statin intolerance
PCSK9 inhibitors
Resumen

Varón de 60 años con hiperlipidemia familiar combinada, cardiopatía isquémica y diabetes tipo 2. Desde la infancia, intolerancia al esfuerzo intenso. Se le diagnosticó enfermedad de McArdle a raíz de rabdomiólisis asociada a estatinas tras un infarto de miocardio. Desde entonces había seguido tratamiento con dieta, fibratos y ezetimiba con buena tolerancia, pero a pesar de ello las concentraciones de colesterol LDL (cLDL) eran >180mg/dl. Se asoció al tratamiento alirocumab 150mg subcutáneos cada 14 días, con excelente respuesta clínica y descenso de cLDL a 15mg/dl, manteniéndose estable desde entonces. Nuestro caso demuestra que los inhibidores de PCSK9 son eficaces y seguros en pacientes con enfermedades musculares que contraindican las estatinas y que son una alternativa terapéutica ideal para este tipo de pacientes.

Palabras clave:
Enfermedad de McArdle
Rabdomiólisis
Intolerancia a estatinas
Inhibidores de PCSK9

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