Expert Opinion on the Use of Inclisiran in Post-Acute Coronary Syndrome Patients in Indonesia
Keywords:
acute coronary syndrome, expert opinion, inclisiran, LDL-C, lipid-lowering therapy, lipid management
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.
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References
1. Mensah GA, Fuster V, Murray CJL, Roth GA, Mensah GA, Abate YH, et al. Global Burden of Cardiovascular Diseases and Risks, 1990-2022. J Am Coll Cardiol. 2023 Dec;82(25):2350–473.
2. Arsyad DS, Hageman SH, Qalby N, Ansariadi, Wahiduddin, Qanitha A, et al. Very High Risk of Recurrent Cardiovascular Events in Indonesian Patients with Established Coronary Heart Disease. Journal of Asian Pacific Society of Cardiology. 2023 Aug 31;2.
3. Arsyad DS, Qalby N, Qanitha A, Mappangara I, Milayanti W, Wahiduddin, et al. Low Attainment of Treatment Targets for Cardiovascular Risk Factors in Indonesian Adults With Established Coronary Artery Disease. J Eval Clin Pract. 2025 Feb 1;31(1).
4. Ference BA, Graham I, Tokgozoglu L, Catapano AL. Impact of Lipids on Cardiovascular Health: JACC Health Promotion Series. Vol. 72, Journal of the American College of Cardiology. Elsevier USA; 2018. p. 1141–56.
5. Rao S V., O’Donoghue ML, Ruel M, Rab T, Tamis-Holland JE, Alexander JH, et al. 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Vol. 151, Circulation. Lippincott Williams and Wilkins; 2025. p. e771–862.
6. Pogran E, Burger AL, Zweiker D, Kaufmann CC, Muthspiel M, Rega-Kaun G, et al. Lipid-Lowering Therapy after Acute Coronary Syndrome. Vol. 13, Journal of Clinical Medicine. Multidisciplinary Digital Publishing Institute (MDPI); 2024.
7. Claessen BE, Guedeney P, Gibson CM, Angiolillo DJ, Cao D, Lepor N, et al. Lipid management in patients presenting with acute coronary syndromes: A review. Vol. 9, Journal of the American Heart Association. American Heart Association Inc.; 2020.
8. Juzar DA, Muzakkir AF, Ilhami YR, Taufiq N, Astiawati T, R A IMJ, et al. Management of Acute Coronary Syndrome Indonesia : Insight from One ACS Multicenter Registry. Indonesian Journal of Cardiology. 2022 Jun 30;43(2):45–55.
9. Mach F, Koskinas KC, Roeters van Lennep JE, Tokgözoğlu L, Badimon L, Baigent C, et al. 2025 Focused Update of the 2019 ESC/EAS Guidelines for the management of dyslipidaemias. Eur Heart J. 2025 Aug 29;
10. Koren MJ, Rodriguez F, East C, Toth PP, Watwe V, Abbas CA, et al. An “Inclisiran First” Strategy vs Usual Care in Patients With Atherosclerotic Cardiovascular Disease. J Am Coll Cardiol. 2024 May 21;83(20):1939–52.
11. Albosta MS, Grant JK, Taub P, Blumenthal RS, Martin SS, Michos ED. Inclisiran: A New Strategy for LDL-C Lowering and Prevention of Atherosclerotic Cardiovascular Disease. Vasc Health Risk Manag. 2023 Jul;Volume 19:421–31.
12. Muzakkir AF, Antonius R. Bridging Gaps in Dyslipidemia Management in Indonesia Through ACS Europath Strategies. Cermin Dunia Kedokteran. 2025 Apr 7;52(4):272–5.
13. Banach M, Reiner Ž, Surma S, Bajraktari G, Bielecka-Dabrowa A, Bunc M, et al. 2024 Recommendations on the Optimal Use of Lipid-Lowering Therapy in Established Atherosclerotic Cardiovascular Disease and Following Acute Coronary Syndromes: A Position Paper of the International Lipid Expert Panel (ILEP). Vol. 84, Drugs. Adis; 2024. p. 1541–77.
14. Cholesterol Treatment Trialists’ (CTT) Collaboration. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170 000 participants in 26 randomised trials. The Lancet. 2010 Nov;376(9753):1670–81.
15. Byrne RA, Rossello X, Coughlan JJ, Barbato E, Berry C, Chieffo A, et al. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J. 2023 Oct 7;44(38):3720–826.
16. Perhimpunan Dokter Spesialis Kardiovaskular Indonesia. Pedoman Tata Laksana Sindrom Koroner Akut Edisi ke-5 [Internet]. 2024 [cited 2025 Aug 15]. Available from: https://www.inaheart.org/storage/guideline/79a8e798c99f99d4af26e724a73e23a1.pdf
17. Schubert J, Leosdottir M, Lindahl B, Westerbergh J, Melhus H, Modica A, et al. Intensive early and sustained lowering of non–high-density lipoprotein cholesterol after myocardial infarction and prognosis: the SWEDEHEART registry. Eur Heart J. 2024 Oct 14;45(39):4204–15.
18. Yadav S, Sawhney JPS. Treatment of dyslipidemia in acute coronary syndrome. Indian Heart J. 2024 Mar;76:S51–7.
19. Ambari AM, Hasan H, Dwiputra B, Desandri DR, Hamdani R, Krevani CK, et al. Indonesia-INTERASPIRE study: an Indonesian cross-sectional multicenter survey on cardiovascular secondary prevention in coronary heart disease. Medical Journal of Indonesia. 2025 Jul 17;34(3):158–66.
20. Lucà F, Oliva F, Rao CM, Abrignani MG, Amico AF, Di Fusco SA, et al. Appropriateness of Dyslipidemia Management Strategies in Post-Acute Coronary Syndrome: A 2023 Update. Vol. 13, Metabolites. Multidisciplinary Digital Publishing Institute (MDPI); 2023.
21. Desai NR, Farbaniec M, Karalis DG. Nonadherence to lipid‐lowering therapy and strategies to improve adherence in patients with atherosclerotic cardiovascular disease. Clin Cardiol. 2023 Jan 20;46(1):13–21.
22. Adam AA, Tiluata LJ, Yunita L, Putra MP, Wilujeng N, Homalessy LV, et al. A Clinical Profile of Acute Coronary Syndrome Patients in Kupang. Indonesian Journal of Cardiology. 2022 Jun 13;42(4):109–18.
23. Dwiputra B, Santoso A, Poh KK. Targeting pro-protein convertase subtilisin kexin-9 as a novel therapy of hypercholesterolemia. Vol. 26, Medical Journal of Indonesia. Faculty of Medicine, Universitas Indonesia; 2017. p. 152–7.
24. Kamanu C, Karalis DG. The Role of Non-Statin Lipid Lowering Therapies to Reduce ASCVD Events in Primary Prevention. Vol. 27, Current Atherosclerosis Reports. Springer; 2025.
25. Deaney C, Donaldson M, Meskauskiene A. A Real-World Retrospective Analysis of Secondary Prevention Patients Treated with Inclisiran over 27 Months. Vol. 19, Clinical Medicine Insights: Cardiology. SAGE Publications Ltd; 2025.
26. Wright RS, Ray KK, Raal FJ, Kallend DG, Jaros M, Koenig W, et al. Pooled Patient-Level Analysis of Inclisiran Trials in Patients With Familial Hypercholesterolemia or Atherosclerosis. J Am Coll Cardiol. 2021 Mar 9;77(9):1182–93.
27. Knowlton K, Navar AM, Anderson J, Brown A, Muhlestein J, Kleeman K, et al. LDL-C management with inclisiran plus usual care vs usual care alone in participants with recent acute coronary syndrome: VICTORION-INCEPTION. J Clin Lipidol. 2025 May;19(3):e109–10.
28. Popadic L, Ma X, Ali Y, Kumparatana P, Wei Y, McElligott S, et al. Treatment Patterns Among Early Inclisiran vs Anti–PCSK9 mAbs Users: A Retrospective Analysis of US Claims Databases. J Clin Lipidol. 2024 Jul;18(4):e515–6.
29. Novartis Pharmaceuticals. SYBRAVA (Inclisiran) 284 mg/1.5 mL Solution for injection Leaflet. 2024.
30. Novartis Pharmaceuticals. Study of Inclisiran to Prevent Cardiovascular (CV) Events in Participants With Established Cardiovascular Disease (VICTORION-2P). 2025.
31. University of Oxford. A Randomized Trial Assessing the Effects of Inclisiran on Clinical Outcomes Among People With Cardiovascular Disease (ORION-4). 2024.
2. Arsyad DS, Hageman SH, Qalby N, Ansariadi, Wahiduddin, Qanitha A, et al. Very High Risk of Recurrent Cardiovascular Events in Indonesian Patients with Established Coronary Heart Disease. Journal of Asian Pacific Society of Cardiology. 2023 Aug 31;2.
3. Arsyad DS, Qalby N, Qanitha A, Mappangara I, Milayanti W, Wahiduddin, et al. Low Attainment of Treatment Targets for Cardiovascular Risk Factors in Indonesian Adults With Established Coronary Artery Disease. J Eval Clin Pract. 2025 Feb 1;31(1).
4. Ference BA, Graham I, Tokgozoglu L, Catapano AL. Impact of Lipids on Cardiovascular Health: JACC Health Promotion Series. Vol. 72, Journal of the American College of Cardiology. Elsevier USA; 2018. p. 1141–56.
5. Rao S V., O’Donoghue ML, Ruel M, Rab T, Tamis-Holland JE, Alexander JH, et al. 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Vol. 151, Circulation. Lippincott Williams and Wilkins; 2025. p. e771–862.
6. Pogran E, Burger AL, Zweiker D, Kaufmann CC, Muthspiel M, Rega-Kaun G, et al. Lipid-Lowering Therapy after Acute Coronary Syndrome. Vol. 13, Journal of Clinical Medicine. Multidisciplinary Digital Publishing Institute (MDPI); 2024.
7. Claessen BE, Guedeney P, Gibson CM, Angiolillo DJ, Cao D, Lepor N, et al. Lipid management in patients presenting with acute coronary syndromes: A review. Vol. 9, Journal of the American Heart Association. American Heart Association Inc.; 2020.
8. Juzar DA, Muzakkir AF, Ilhami YR, Taufiq N, Astiawati T, R A IMJ, et al. Management of Acute Coronary Syndrome Indonesia : Insight from One ACS Multicenter Registry. Indonesian Journal of Cardiology. 2022 Jun 30;43(2):45–55.
9. Mach F, Koskinas KC, Roeters van Lennep JE, Tokgözoğlu L, Badimon L, Baigent C, et al. 2025 Focused Update of the 2019 ESC/EAS Guidelines for the management of dyslipidaemias. Eur Heart J. 2025 Aug 29;
10. Koren MJ, Rodriguez F, East C, Toth PP, Watwe V, Abbas CA, et al. An “Inclisiran First” Strategy vs Usual Care in Patients With Atherosclerotic Cardiovascular Disease. J Am Coll Cardiol. 2024 May 21;83(20):1939–52.
11. Albosta MS, Grant JK, Taub P, Blumenthal RS, Martin SS, Michos ED. Inclisiran: A New Strategy for LDL-C Lowering and Prevention of Atherosclerotic Cardiovascular Disease. Vasc Health Risk Manag. 2023 Jul;Volume 19:421–31.
12. Muzakkir AF, Antonius R. Bridging Gaps in Dyslipidemia Management in Indonesia Through ACS Europath Strategies. Cermin Dunia Kedokteran. 2025 Apr 7;52(4):272–5.
13. Banach M, Reiner Ž, Surma S, Bajraktari G, Bielecka-Dabrowa A, Bunc M, et al. 2024 Recommendations on the Optimal Use of Lipid-Lowering Therapy in Established Atherosclerotic Cardiovascular Disease and Following Acute Coronary Syndromes: A Position Paper of the International Lipid Expert Panel (ILEP). Vol. 84, Drugs. Adis; 2024. p. 1541–77.
14. Cholesterol Treatment Trialists’ (CTT) Collaboration. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170 000 participants in 26 randomised trials. The Lancet. 2010 Nov;376(9753):1670–81.
15. Byrne RA, Rossello X, Coughlan JJ, Barbato E, Berry C, Chieffo A, et al. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J. 2023 Oct 7;44(38):3720–826.
16. Perhimpunan Dokter Spesialis Kardiovaskular Indonesia. Pedoman Tata Laksana Sindrom Koroner Akut Edisi ke-5 [Internet]. 2024 [cited 2025 Aug 15]. Available from: https://www.inaheart.org/storage/guideline/79a8e798c99f99d4af26e724a73e23a1.pdf
17. Schubert J, Leosdottir M, Lindahl B, Westerbergh J, Melhus H, Modica A, et al. Intensive early and sustained lowering of non–high-density lipoprotein cholesterol after myocardial infarction and prognosis: the SWEDEHEART registry. Eur Heart J. 2024 Oct 14;45(39):4204–15.
18. Yadav S, Sawhney JPS. Treatment of dyslipidemia in acute coronary syndrome. Indian Heart J. 2024 Mar;76:S51–7.
19. Ambari AM, Hasan H, Dwiputra B, Desandri DR, Hamdani R, Krevani CK, et al. Indonesia-INTERASPIRE study: an Indonesian cross-sectional multicenter survey on cardiovascular secondary prevention in coronary heart disease. Medical Journal of Indonesia. 2025 Jul 17;34(3):158–66.
20. Lucà F, Oliva F, Rao CM, Abrignani MG, Amico AF, Di Fusco SA, et al. Appropriateness of Dyslipidemia Management Strategies in Post-Acute Coronary Syndrome: A 2023 Update. Vol. 13, Metabolites. Multidisciplinary Digital Publishing Institute (MDPI); 2023.
21. Desai NR, Farbaniec M, Karalis DG. Nonadherence to lipid‐lowering therapy and strategies to improve adherence in patients with atherosclerotic cardiovascular disease. Clin Cardiol. 2023 Jan 20;46(1):13–21.
22. Adam AA, Tiluata LJ, Yunita L, Putra MP, Wilujeng N, Homalessy LV, et al. A Clinical Profile of Acute Coronary Syndrome Patients in Kupang. Indonesian Journal of Cardiology. 2022 Jun 13;42(4):109–18.
23. Dwiputra B, Santoso A, Poh KK. Targeting pro-protein convertase subtilisin kexin-9 as a novel therapy of hypercholesterolemia. Vol. 26, Medical Journal of Indonesia. Faculty of Medicine, Universitas Indonesia; 2017. p. 152–7.
24. Kamanu C, Karalis DG. The Role of Non-Statin Lipid Lowering Therapies to Reduce ASCVD Events in Primary Prevention. Vol. 27, Current Atherosclerosis Reports. Springer; 2025.
25. Deaney C, Donaldson M, Meskauskiene A. A Real-World Retrospective Analysis of Secondary Prevention Patients Treated with Inclisiran over 27 Months. Vol. 19, Clinical Medicine Insights: Cardiology. SAGE Publications Ltd; 2025.
26. Wright RS, Ray KK, Raal FJ, Kallend DG, Jaros M, Koenig W, et al. Pooled Patient-Level Analysis of Inclisiran Trials in Patients With Familial Hypercholesterolemia or Atherosclerosis. J Am Coll Cardiol. 2021 Mar 9;77(9):1182–93.
27. Knowlton K, Navar AM, Anderson J, Brown A, Muhlestein J, Kleeman K, et al. LDL-C management with inclisiran plus usual care vs usual care alone in participants with recent acute coronary syndrome: VICTORION-INCEPTION. J Clin Lipidol. 2025 May;19(3):e109–10.
28. Popadic L, Ma X, Ali Y, Kumparatana P, Wei Y, McElligott S, et al. Treatment Patterns Among Early Inclisiran vs Anti–PCSK9 mAbs Users: A Retrospective Analysis of US Claims Databases. J Clin Lipidol. 2024 Jul;18(4):e515–6.
29. Novartis Pharmaceuticals. SYBRAVA (Inclisiran) 284 mg/1.5 mL Solution for injection Leaflet. 2024.
30. Novartis Pharmaceuticals. Study of Inclisiran to Prevent Cardiovascular (CV) Events in Participants With Established Cardiovascular Disease (VICTORION-2P). 2025.
31. University of Oxford. A Randomized Trial Assessing the Effects of Inclisiran on Clinical Outcomes Among People With Cardiovascular Disease (ORION-4). 2024.
Published
2026-09-08
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How to Cite
Juzar, D., Ng, S., Firdaus, I., Muzakkir, A., Widyantoro, B., Habib, F., Bagaswoto, H., Danny, S., Erwinanto, E., & Santoso, A. (2026). Expert Opinion on the Use of Inclisiran in Post-Acute Coronary Syndrome Patients in Indonesia. Indonesian Journal of Cardiology. https://doi.org/10.30701/ijc.1991
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