PCSK9 inhibitors significantly reduced carotid intima-media thickness by a mean difference of -0.01 mm compared to placebo, correlating with differences in total and LDL cholesterol.
Do PCSK9 inhibitors reduce carotid intima-media thickness in patients receiving statin therapy?
PCSK9 inhibitors are associated with a significant reduction in carotid intima-media thickness, which correlates with reductions in total and LDL cholesterol, indicating a lipid-mediated vascular response.
Tasa de eventos absoluta: 0% vs 0%
Abstract Objective We assessed impact of PCSK9 inhibitors (PCSK9i) on carotid intima-media thickness (cIMT) and their interplay with lipid profile parameters. Methods Systematic review conducted in accordance with PRISMA guidelines. Primary endpoint was cIMT reduction (millimetres). Meta-regression examined influence of demographic, imaging, and biochemical parameters on cIMT. Heterogeneity exploration was conducted via leave-one-out and Baujat plot analyses. Results Four randomized controlled trials comparing PCSK9i plus statin versus placebo plus statin, and two single-arm studies were included, enrolling 607 patients and 2175 carotid segments. Pooled analysis demonstrated significant reduction in cIMT; mean difference (MD) −0.03 (95%c.i.: −0.05 to −0.01) (I2 = 95.4%, P 0.01). Following exploration and mitigation of heterogeneity, this reduction persisted; MD −0.01 (95%c.i.: −0.02 to −0.01) (I2 = 0%, P = 0.59). Initially, comparison between PCSK9i and placebo yielded non-significant cIMT reduction favouring PCSK9i; MD −0.04 (95%c.i.: −0.10 to 0.03) (I² = 98.6%, P 0.01). Following heterogeneity adjustment, effect estimate reached statistical significance, demonstrating consistent cIMT reduction with PCSK9i; MD −0.01 (95%c.i.: −0.02 to −0.01) (I² = 52%, P = 0.12). Meta-regression displayed associations between baseline cIMT (β = −0.45, P 0.01), HDL (β = 1.92, P 0.01) and cIMT. Pooled between-group cIMT differences showed moderate correlations with the respective differences in total (r = 0.69) and LDL cholesterol (r = 0.59). Conclusions Evidence supports potential association between PCSK9i treatment and cIMT reduction, with observed correlations involving total and LDL cholesterol indicating lipid-mediated vascular response. These findings warrant cautious interpretation given substantial heterogeneity, partly driven by baseline differences in cIMT and lipid profiles. Future studies should ensure baseline comparability in vascular and biochemical parameters to strengthen causal inferences.
Bontinis et al. (Sun,) reported a other. PCSK9 inhibitors significantly reduced carotid intima-media thickness by a mean difference of -0.01 mm compared to placebo, correlating with differences in total and LDL cholesterol.