Abstract Number: Esoc2026a1486 Real-World Data on the Efficacy and Tolerability of Highly Effective Lipid-Lowering Therapies for LDL Cholesterol Control in an Atherothrombotic Stroke Outpatient Clinic

Abstract Background and aims Although persistently high LDL cholesterol (LDL-C) levels are associated with recurrent atherothrombotic stroke, highly-effective LDL-lowering treatments such as PCSK9 inhibitors (iPCSK9) and small interfering RNA are now available. This study aims to evaluate real-world effectiveness and safety of such therapies among atherothrombotic stroke patients. Methods A retrospective observational study was conducted in stroke patients treated with iPCSK9 or inclisiran between January 2022 and October 2025 in an outpatient clinic attended by stroke neurologists and nurses, specially dedicated on LDL-C control to prevent stroke recurrence. Baseline characteristics, cLDL reduction and side effects were recorded. Results Of 199 atherothrombotic stroke patients evaluated, 70 required highly-effective treatments. 8 (12%) started the treatment at hospital discharge, while the remaining patients started during follow-up due to persistently high LDL-C levels despite statin or intolerance (34%). 51 (73%) received iPCSK9 (mostly Evolocumab), with a mean LDL-C reduction of 57% from baseline and 72% achieved target levels, with 86% adherence and a current average treatment duration of 629 days. 19 (28%) received inclisiran, achieving a mean LDL-C reduction of 57% from baseline, with 81 % of patients reaching the lipid target, with 94% adherence and a current average treatment duration of 310 days. Regarding side effects, one case of hypomagnesemia was reported, although not clearly associated with iPCSK9. During follow-up, no patient suffered stroke recurrence. Conclusions iPCSK9 and inclisiran are effective for lipid control and the prevention of stroke, with excellent tolerability and safety profile even in real-world conditions.The consistency of these results should be evaluated in future long-term studies. Conflict of interest Adelaida Cuenca Relinque: nothing to disclose