PCSK9 inhibitors on the management of primary and secondary cardiovascular prevention.

Autor: Marco-Benedí V; Hospital Universitario Miguel Servet, IIS Aragón, CIBERCV, Saragossa, Spain. vmarcobenedi@gmail.com.; Unidad de Lípidos, Hospital Universitario Miguel Servet, Avda Isabel La Católica 1-3, 50009, Saragossa, Spain. vmarcobenedi@gmail.com., Sánchez-Hernández RM; Sección de Endocrinología y Nutrición, Complejo Hospitalario Universitario Insular Materno-Infantil, Instituto Universitario de Investigaciones Biomédicas y Sanitarias de La Universidad de Las Palmas de Gran Canaria, de Las Palmas de Gran Canaria, Spain., Díaz JL; Unidad de Lípidos y Riesgo Cardiovascular, Medicina Interna, Hospital Universitario A Coruña, A Coruña, Spain., Jarauta E; Hospital Universitario Miguel Servet, IIS Aragón, CIBERCV, Saragossa, Spain.; Unidad de Lípidos, Hospital Universitario Miguel Servet, Avda Isabel La Católica 1-3, 50009, Saragossa, Spain., Suárez-Tembra M; Unidad de Lípidos y Riesgo Cardiovascular Hospital San Rafael, A Coruña, Spain., Pintó X; Unidad de Lípidos y Riesgo Cardiovascular, Servicio de Medicina Interna, Hospital Universitario de Bellvitge, CIBEROBN, Barcelona, Spain., Morillas C; Unidad de Lípidos Clínico-Epidemiológica, Hospital Universitario Dr. Peset, Valencia, Spain., Plana N; Unitat de Medicina Vascular I Metabolisme, Hospital Sant Joan de Reus, IISPV, CIBERDEM, Universitat Rovira I Virgili, Reus, Spain., Pedro-Botet J; Unidad de Lípidos y Riesgo Vascular, Servicio de Endocrinología y Nutrición, Hospital del Mar, Universidad Autónoma de Barcelona, Barcelona, Spain., Civeira F; Hospital Universitario Miguel Servet, IIS Aragón, CIBERCV, Saragossa, Spain. civeira@unizar.es.; Unidad de Lípidos, Hospital Universitario Miguel Servet, Avda Isabel La Católica 1-3, 50009, Saragossa, Spain. civeira@unizar.es.
Jazyk: angličtina
Zdroj: Lipids in health and disease [Lipids Health Dis] 2024 Sep 10; Vol. 23 (1), pp. 290. Date of Electronic Publication: 2024 Sep 10.
DOI: 10.1186/s12944-024-02283-x
Abstrakt: Background: Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) have represented an important change in the management of hypercholesterolemia, although, until now, they have barely been used. Without PCSK9i, many patients with atherosclerotic cardiovascular disease (CVD) or those at very high risk do not reach their therapeutic LDLc objectives.
Objective: The analysis aimed to examine the clinical and biochemical characteristics of subjects receiving PCSK9i treatment in the Dyslipidemia Registry of the Spanish Atherosclerosis Society.
Methods: All consecutive subjects aged ≥ 18 years from different Lipid Units included in the Dyslipidemia Registry of the SEA were analyzed. Inclusion criteria consisted of unrelated patients aged ≥ 18 at the time of inclusion with hypercholesterolemia (LDL-C ≥ 130 mg/dL or non-HDL-C ≥ 160 mg/dL after the exclusion of secondary causes) who were studied for at least two years after inclusion. Participants' baseline and final visit clinical and biochemical characteristics were analyzed based on whether they were on primary or secondary prevention and whether they were taking PCSK9i at the end of follow-up.
Results: Eight hundred twenty-nine patients were analyzed, 7014 patients in primary prevention and 1281 in secondary prevention at baseline. 4127 subjects completed the required follow-up for the final analysis. The median follow-up duration was 7 years (IQR 3.0-10.0). Five hundred patients (12.1%) were taking PCSK9i at the end of the follow-up. The percentage of PCSK9i use reached 35.6% (n = 201) and 8.7% (n = 318) in subjects with and without CVD, respectively. Subjects on PCSK9i and oral lipid-lowering agents with and without CVD achieved LDLc reductions of 80.3% and 75.1%, respectively, concerning concentrations without lipid-lowering drugs. Factors associated with PCSK9i use included increasing age, LDLc without lipid-lowering drugs and the Dutch Lipid Clinic Network (DLCN) score. However, hypertension, diabetes, smoking, and LDLc after oral lipid-lowering drugs were not independent factors associated with PCSK9i prescription. In subjects with CVD, the use of PCSK9i was higher in men than in women (an odds ratio of 1.613, P = 0.048).
Conclusions: Approximately one-third of CVD patients received PCSK9i at the end of follow-up. The use of PCSK9i was more focused on baseline LDLc concentrations rather than on CVD risk. Women received less PCSK9i in secondary prevention compared to men.
(© 2024. The Author(s).)
Databáze: MEDLINE
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