{"id":"1f144c1e62e4","type":"article","url":"https://hartvaat.nl/2026/02/23/pcsk9-remmers-bij-cardiaal-syndroom-x-nieuw-perspectief-op-microvasculaire-angin/","title":"PCSK9-remmers bij cardiaal syndroom X: nieuw perspectief op microvasculaire angina","title_en":"The possible role of PCSK9 inhibitors in cardiac syndrome X: Bridging microvascular dysfunction, endothelial pathobiology, and molecular pharmacotherapy.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog"],"tags":["acuut-coronair-syndroom","enlicitide","ezetimibe","laminopathie","microvasculaire-angina","niet-statine-therapie","pcsk9-remmers","pcsk9-remmers-nieuwe-generatie","ras-remmers"],"journal":"Microvascular research","doi":"10.1016/j.mvr.2026.104925","source_url":"https://doi.org/10.1016/j.mvr.2026.104925","authors":["Sherouk Hussein Sweilam","Hayder M Al-Kuraishy","Aya M Mustafa","Shaimaa M Hassan","Reem Alsharari","Gaber El-Saber Batiha"],"significance":3,"published":"2026-02-23","source_date":"2026-02-23","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/ldl-cholesterol-mechanisme/"],"congress":"","summary_en":"This review discusses the potential role of PCSK9 inhibitors in cardiac syndrome X (microvascular angina), highlighting their effects beyond lipid lowering on endothelial dysfunction, oxidative stress, and inflammation — mechanisms central to microvascular angina pathophysiology.","created":"2026-07-03T10:24:56Z","updated":"2026-07-03T13:24:25Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Dit reviewartikel bespreekt de mogelijke rol van PCSK9-remmers bij cardiaal syndroom X (microvasculaire angina). Naast hun lipideverlagende werking kunnen PCSK9-remmers endotheeldisfunctie, oxidatieve stress en inflammatie gunstig beïnvloeden — mechanismen die centraal staan in de pathofysiologie van microvasculaire angina, vooral bij postmenopauzale vrouwen.","abstract_original":"Cardiac syndrome X (CSX), historically used to describe angina with normal coronary angiography and now largely encompassed within microvascular angina and INOCA, is an ischemic disorder characterized by angina pectoris without narrowing of coronary arteries. CSX, which primarily affects postmenopausal women, is driven by coronary micro-vascular dysfunction, endothelial impairment, oxidative stress, and chronic low-grade inflammation. Notably, the Conventional anti-anginal therapies often yield limited symptom relief, underscoring the need for novel mechanism-based approaches. Proprotein Convertase Subtilisin/Kexin type 9 (PCSK9) has emerged as a pivotal mediator linking dyslipidemia to endothelial dysfunction, oxidative injury, and vascular inflammation. Elevated PCSK9 suppresses endothelial nitric oxide synthase, enhances reactive oxygen species generation, promotes cytokines such as IL-6 and TNF-α, and increases platelet activation. Therefore, PCSK9 inhibitors such as alirocumab, evolocumab, and inclisiran, have been shown to improve endothelial function, reduce arterial stiffness, and attenuate oxidative and inflammatory stress. Consequently, PCSK9 inhibition may be a promising therapeutic strategy for CSX. Thus, this review aimed to discuss and explain the potential role of PCSK9 in the pathogenesis of CSX, and how PCSK9 inhibitors could be effective in managing patients with CSX."}