PCSK9 inhibitors reduced LDL cholesterol by 54.7% one month after treatment in heart transplant patients without increasing rejection or donor-specific antibodies.
Do PCSK9 inhibitors reduce LDL cholesterol in heart transplant patients with suboptimal lipid control?
PCSK9 inhibitors safely and effectively reduce LDL cholesterol by over 50% at one month in heart transplant recipients with suboptimal lipid control.
Abstract Background Dyslipidemia is very frequent after heart transplant (HT) for multiple reasons, pre-transplant history (ischemic cardiac disease is the most common cause of HT in our country) and immunosuppression comorbidities. Cardiac allograft vasculopathy (CAV) has been related to hypercholesterolemia, and transplanted coronary arteries are more vulnerable to dyslipidemia. The use of statins is recommended in every HT patient regardless their cholesterol blood level. Purpose The use of statins in HT patients and their benefit are very well stablished. Sometimes intolerance and interactions with immunosuppression force to stop them or might not be enough to achieve low-density lipoprotein (LDL) cholesterol goals. We studied cholesterol reduction and safety with the use of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors in a multicenter cohort of Heart Transplant (HT) patients. Methods In a retrospective multicenter study, we identified HT patients with LDL cholesterol suboptimal control, treated with PCSK9i. The primary endpoint was LDL reduction one month after, and secondary endpoints were the development of donor-specific HLA antibodies (DSA) and the presence of coronary allograft vasculopathy or rejection. Results 36 HT patients from 8 hospitals in our country received PCSK9i from May 2018 to August 2024. Total cholesterol at baseline was 208.9±53.4 mg/dL, and at one month was reduced to 133.6±50.7 mg/dL, meaning a reduction of 72.4±42.4 mg/dL, which supposed a 34.6% from basal level. LDL cholesterol was 127.6±52.0 mg/dL before treatment, dropping to 54±33.8 mg/dL at 1 month, a reduction of 72.3±41.9 (54.7%). There was not significant difference about patients that presented donor-specific HLA antibodies (DSA), coronary allograft vasculopathy or rejection between prior and after treatment. Conclusions PCSK9i are a safe and effective option for lowering cholesterol levels in patients that have undergone HT. Although CAV reduction is not demonstrated, we should aim to a strict cholesterol control to avoid cardiovascular events.Total al LDL cholesterol reduction
Valero et al. (2025) studied this question. PCSK9 inhibitors reduced LDL cholesterol by 54.7% one month after treatment in heart transplant patients without increasing rejection or donor-specific antibodies.