PCSK9 inhibitors usage in South China: A Multi-Center Real-World Study

Q: What are the key findings of this study?

PCSK9 inhibitor initiation in high-risk patients across the Greater Bay Area of China resulted in median LDL-C reductions of 38-56%, with 60-70% achieving an LDL-C <1.8 mmol/L.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Atherosclerotic cardiovascular disease (ASCVD) (n=9828). Intervention: Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i). Primary outcome: Low-density lipoprotein cholesterol (LDL-C) reduction and goal attainment post-initiation.

Q: What does this research mean for the field?

Real-world PCSK9 inhibitor initiation produces substantial LDL-C reductions (median 38–56%) with 60–70% of high-risk patients achieving LDL-C <1.8 mmol/L in South China, though prescribing uptake is strongly shaped by local reimbursement policies. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Qiuyan Yu; Tiantian Ma; Fengmei Huang; Olivia Monteiro; Edmundo Patricio Lopes Lao; Io Chon Vong; Sam In Ung; Shasha Li; Shaorong Wu; Jinghao Wang; Joseph E. Blais; Kathryn Choon Beng Tan; David Tak Wai Lui; Kai-Hang Yiu; Ian Chi Kei Wong; Celine Sze Ling Chui

doi:10.1007/s40801-026-00586-2

October 6, 2026Drugs - Real World OutcomesOpen Access

PCSK9 inhibitors usage in South China: A Multi-Center Real-World Study

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Key result

PCSK9 inhibitor initiation linked to ~47% median LDL-C reduction in high-risk Chinese patients.

n=9,828

Why the study?

Regional variations in healthcare policies in the Guangdong-Hong Kong-Macau Greater Bay Area create inequities in PCSK9i drug access that remain unexplored.

Does alirocumab or evolocumab reduce low-density lipoprotein cholesterol in high-risk adult patients in real-world settings across South China?

Key Points

To compare real-world PCSK9 inhibitor utilization, prescribing trends before and after 2021 funding changes, and post-initiation LDL-C goal attainment across disparate healthcare systems in the Greater Bay Area.
Multi-center cohort study analyzing electronic health records across five centers in Hong Kong, Macau, Shenzhen, and Guangzhou from August 2016 to December 2024.
Included adult (aged ≥18 years) new users of alirocumab or evolocumab (total N=9828; HKHA = 3296, HKU-SZH = 2529, SSM = 148, MUST-UH = 87, JNUH = 3768) with a high burden of atherosclerotic cardiovascular disease.
Prescribing trends showed divergent uptake, with mainland centers (JNUH and HKU-SZH) experiencing the highest uptake following inclusion in China's National Reimbursement Drug List.
Therapy initiation produced median LDL-C reductions of 38–56%, with approximately 60–70% of patients achieving LDL-C <1.8 mmol/L across most centers.

Study Design

Type

Cohort (n=9,828)

Multicenter

Yes

Structured PICO

Does alirocumab or evolocumab reduce low-density lipoprotein cholesterol in high-risk adult patients in real-world settings across South China?

P

Population

9,828 adult new users of PCSK9 inhibitors with a high burden of atherosclerotic cardiovascular disease from five centers in the Greater Bay Area of China, followed for up to 1 year.

E

Exposure

Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) initiation (alirocumab or evolocumab)

O

Outcome

Prescribing trends and low-density lipoprotein cholesterol (LDL-C) goal attainment (<1.8 mmol/L, <1.4 mmol/L, <1.0 mmol/L, and ≥50% reduction from baseline) at 180 and 365 days post-initiationsurrogate

Real-world data from the Greater Bay Area in South China demonstrate that PCSK9 inhibitors yield substantial LDL-C reductions and high goal attainment in high-risk patients, while highlighting that differing reimbursement policies drive significant regional variations in prescribing uptake.

Limitations

Missing socioeconomic information due to retrospective nature of EHR data
Documentation of comorbidities dependent on varied clinical coding practices across healthcare systems
Data on statin intolerance was not systematically captured
Medication adherence information and concomitant use of other lipid-lowering therapies post-initiation could not be systematically assessed
Small sample sizes in some study centers (e.g., Macau health systems)

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

Real-world PCSK9 inhibitor use was associated with substantial LDL-C reductions across Greater Bay Area centers; extends trial data but leaves open long-term outcome confirmation.

Abstract

Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) are effective for lipid management in high-risk patients with atherosclerotic cardiovascular disease. Their inclusion in China’s National Reimbursement Drug List and the Hong Kong Hospital Authority Drug Formulary in 2021 improved accessibility. The Guangdong-Hong Kong-Macau Greater Bay Area is a unique integrated economic zone in Southern China where divergent healthcare systems coexist. How these disparate policies create inequities in drug access remains unexplored for regional health integration. This study aimed to compare real-world PCSK9i utilization and effect across the Greater Bay Area. This multi-center cohort study analyzed electronic health records from five centers: Hong Kong Hospital Authority (HKHA) [Hong Kong], Macau Health Bureau (SSM) [Macau public], Macau University of Science and Technology Hospital - University Hospital (MUST-UH) [Macau private], Hong Kong-Shenzhen Hospital (HKU-SZH) [Shenzhen], and First Affiliated Hospital of Jinan University (JNUH) [Guangzhou], between August 2016 and December 2024, with center-specific start dates reflecting local PCSK9i availability. Adult (aged ≥18 years) new users of alirocumab or evolocumab were included. We investigated prescribing trends and evaluated the low-density lipoprotein cholesterol (LDL-C) goal attainment post-initiation. There were total of 9828 new users (HKHA = 3296, HKU-SZH = 2529, SSM = 148, MUST-UH = 87, JNUH = 3768), agent choice varied with evolocumab most commonly prescribed in HKHA, MUST-UH, and JNUH, while alirocumab was most common in HKU-SZH and SSM. Patients were predominantly older male individuals with a high burden of atherosclerotic cardiovascular disease. Prescribing trends showed a divergent uptake, with the highest uptake in mainland centers (JNUH and HKU-SZH) post-National Reimbursement Drug List inclusion. Substantial LDL-C reductions were observed after PCSK9i initiation (median reductions of 38–56%). Approximately 60–70% of patients achieved an LDL-C <1.8 mmol/L in most centers, though attainment was slightly lower in JNUH. In the largest real-world study of PCSK9i in Asia, therapy was primarily used in high-risk patients, and substantial LDL-C reductions with high goal attainment were observed following its initiation. The observed regional variations in prescribing patterns highlight the impact of local healthcare policies. The findings provide a robust model for multi-jurisdictional evidence generation and highlight the need for further research on whether harmonized access policies could improve lipid management and reduce the cardiovascular burden across East Asia.

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Cite This Study

Yu et al. (2026) conducted a cohort in Atherosclerotic cardiovascular disease (ASCVD) (n=9,828). Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) was evaluated on Low-density lipoprotein cholesterol (LDL-C) reduction and goal attainment post-initiation. PCSK9 inhibitor initiation in high-risk patients across the Greater Bay Area of China resulted in median LDL-C reductions of 38-56%, with 60-70% achieving an LDL-C <1.8 mmol/L.

synapsesocial.com/papers/6ac74632947fe0d7c56432a6 https://doi.org/10.1007/s40801-026-00586-2

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PCSK9 inhibitors usage in South China: A Multi-Center Real-World Study

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

PCSK9 inhibitors usage in South China: A Multi-Center Real-World Study

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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