Sex Differences in Cardiovascular Outcomes and Cholesterol-Lowering Efficacy of PCSK9 Inhibitors: Systematic Review and Meta-Analysis.

Autor:	Rivera FB; Department of Medicine, Lincoln Medical Center, Bronx, New York, USA., Cha SW; Department of Medicine, Cebu Institute of Medicine, Cebu City, Cebu, Philippines., Aparece JP; Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA., Rocimo A; Department of Medicine, University of the Philippines System, Manila, National Capital Region, Philippines., Ong BA; Department of Medicine, University of the Philippines System, Manila, National Capital Region, Philippines., Golbin JM; Department of Medicine, University of the Philippines System, Manila, National Capital Region, Philippines., Alfonso PG; Department of Medicine, University of the Philippines System, Manila, National Capital Region, Philippines., Enkhmaa B; Section of Endocrinology, Diabetes & Metabolism, UC Davis Health Systems, Davis, California, USA., Khan SU; Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA., Cainzos-Achirica M; Cardiólogo y epidemiólogo cardiovascular, Hospital del Mar/Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain., Volgman AS; Division of Cardiology, Rush University Medical Center, Chicago, Illinois, USA., Navar AM; Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA., Shah NP; Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA.
Jazyk:	angličtina
Zdroj:	JACC. Advances [JACC Adv] 2023 Oct 28; Vol. 2 (9), pp. 100669. Date of Electronic Publication: 2023 Oct 28 (Print Publication: 2023).
DOI:	10.1016/j.jacadv.2023.100669
Abstrakt:	Background: Guideline-recommended low-density lipoprotein cholesterol (LDL-C) thresholds are often not achieved in women. The proprotein convertase subtilisin/kexin type-9 inhibitor (PCSK9i) monoclonal antibodies can help further reduce LDL-C and major adverse cardiovascular events (MACE) although differences in efficacy by sex and type are less understood. Objectives: The authors sought to determine if there are differences in the efficacy of LDL-C lowering and reduction in the risk of MACE by sex and type of PCSK9i. Methods: A comprehensive literature search was done through October 17, 2022, for published trials comparing PCSK9i vs control. Outcomes assessed were LDL-C reduction and incidence of MACE following the use of PCSK9i vs placebo, stratified by sex and type of PCSK9i used. Results: We identified 16 trials with 54,996 adults, and 15,143 (27.5%) of them were female. PCSK9i significantly reduced MACE compared to placebo in both women (HR: 0.86, 95% CI: 0.74-0.97, P  < 0.001) and men (HR: 0.85, 95% CI: 0.79-0.91, P  < 0.001) with no significant sex difference (MD -0.01, 95% CI: -0.14 to -0.13, P  = 0.930). PCSK9i also significantly reduced LDL-C levels in both sexes at 12 weeks (females: MD -62.57, 95% CI: -70.24 to -54.91, P  < 0.001; males: MD -66.19, 95% CI: -72.03 to -60.34, P  < 0.001) and 24 weeks (females: MD -47.52, 95% CI: -52.94 to -42.09, P  < 0.001; males: MD -54.07, 95% CI: -59.46 to -48.68, P  < 0.001). Significant sex difference was seen in the LDL reduction of PCSK9i for both 12 weeks (males vs females: MD -4.55, 95% CI: -7.34 to -1.75, P  < 0.01) and 24 weeks (males vs females: MD -7.11, 95% CI: -9.99 to -4.23, P  < 0.001). Conclusions: The use of PCSK9i results in significant LDL-C and MACE reduction in both males and females. While there is no significant sex difference in MACE reduction, LDL-C reduction is greater in males than in females. Our data support the equal use of PCSK9i in all eligible patients, regardless of sex. Competing Interests: The authors have reported that they have no relationships relevant to the contents of this paper to disclose. (© 2023 The Authors.)
Databáze:	MEDLINE
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