High-dose statin therapy was significantly superior to PCSK9 inhibitor-statin for reducing major cardiovascular events (RR 0.86 vs 0.94) per 1 mmol/L reduction of LDL-C in secondary prevention.
Meta-Analysis (n=131,978)
Yes
Does more intensive lipid-lowering therapy (high-dose statin, ezetimibe-statin, or PCSK9 inhibitor-statin) reduce major cardiovascular events and revascularization in secondary prevention patients?
In secondary prevention patients, high-dose statins provide significantly superior reduction in MACE and revascularization per 1 mmol/L LDL-C reduction compared to PCSK9 inhibitor-statin combinations.
Relative Risk: 0.91 (95% CI 0.88–0.94)
Absolute Event Rate: 13.25% vs 14.95%
BACKGROUND: We aimed to investigate the comparative cardiovascular benefits of high-dose statin, ezetimibe-statin, and PCSK9 inhibitor-statin treatments in secondary prevention patients. METHODS AND RESULTS: We selected 12 randomized controlled trials (n=131,978 patients) using PubMed and Embase (inception-June 1, 2018). Subgroup differences were explored by meta-regression and Cochran Q test. The relative effects of high-dose statin, ezetimibe-statin, and PCSK9 inhibitor-statin on major cardiovascular events (MACE), and revascularization were varied and decreased gradually, of which high-dose statin resulted in lower risk of MACE and revascularization than PCSK9 inhibitor-statin per 1 mmol/L reduction of low-density lipoprotein cholesterol (LDL-C): risk ratio (RR) for MACE, 0.86 (95% confidence interval (CI), 0.81-0.90) for high-dose statin, 0.90 (95% CI, 0.83-0.96) for ezetimibe-statin, and 0.94 (95% CI, 0.92-0.96) for PCSK9 inhibitor-statin; RR for revascularization, 0.84 (95% CI, 0.77-0.90) for high-dose statin, 0.91 (95% CI, 0.81-1.00) for ezetimibe-statin, and 0.94 (95% CI, 0.90-0.97) for PCSK9 inhibitor-statin. Similar relative effects of intensive lipid-lowering treatment were also observed in analyses of myocardial infarction and stroke, although no significant difference between groups was identified. CONCLUSIONS: In secondary prevention patients, the relative benefits of high-dose statin, ezetimibe-statin, and PCSK9 inhibitor-statin treatments were varied and decreased gradually, of which high-dose statin was significantly superior to PCSK9 inhibitor-statin for improving MACE and revascularization per 1 mmol/L reduction of LDL-C.
Wang et al. (Thu,) conducted a meta-analysis in Secondary prevention of cardiovascular disease (n=131,978). Intensive lipid-lowering therapy vs. Less-intensive lipid-lowering therapy was evaluated on Major cardiovascular events (MACE) (RR 0.91, 95% CI 0.88-0.94). High-dose statin therapy was significantly superior to PCSK9 inhibitor-statin for reducing major cardiovascular events (RR 0.86 vs 0.94) per 1 mmol/L reduction of LDL-C in secondary prevention.