Key result
Age >=75 linked to ~53% lower odds of initiating PCSK9 therapy after MI or stroke.
Cohort (n=81,366)
Yes
Real-world initiation of PCSK9-targeted therapies within 24 months after myocardial infarction (<2%) or ischemic stroke (<1%) remains critically low in the Czech Republic, with significant age- and region-based disparities driven by structural and reimbursement barriers.
Low post-MI PCSK9 uptake may reflect underuse; leaves open research on age-related access barriers.
Background Proprotein convertase subtilisin/kexin 9 (PCSK9)–targeted therapies substantially reduce LDL cholesterol and recurrent major cardiovascular events in very high-risk patients following myocardial infarction (MI) or ischemic stroke, yet real-world implementation remains critically insufficient despite robust trial evidence and Class I ESC guideline recommendations. Purpose To evaluate 24-month initiation rates of PCSK9-targeted therapies [monoclonal antibodies (mAbs) and inclisiran] following MI and ischemic stroke across the entire Czech national population, and to quantify disparities by age, sex, region, and therapeutic class (mAbs vs. inclisiran). Methods A nationwide population-based cohort study was conducted using the National Registry of Reimbursed Health Services, encompassing complete reimbursement data from all statutory health insurers. All adults hospitalized with incident MI (ICD-10 I21–I22) or ischemic stroke (I63) between 2018 and 2024 were included. Therapy initiation within 24 months was the primary endpoint. Multivariable logistic regression identified independent predictors, including sex, age group (<65, 65–74, ≥75 years), and region. Results Among 81,366 patients with incident MI, only 780 (1.0%) initiated PCSK9-targeted therapy within 24 months. Uptake increased from 0.2% (2018) to 2.0% (2023) yet remained markedly low. A pronounced age gradient was observed: 1.5% (<65 years), 0.9% (65–74 years), and 0.3% (≥75 years); patients ≥75 years had an adjusted OR of ~0.47 for treatment initiation. Substantial regional heterogeneity was observed; sex differences were modest. Initiation rates after ischemic stroke were uniformly lower than after MI across all calendar years (<1%), with pronounced age-related disparities. Notably, inclisiran surpassed monoclonal antibodies in recent initiations, potentially reflecting system-level prescribing constraints at lipid centers. Conclusions In this comprehensive national analysis, fewer than 2% of post-MI patients and fewer than 1% of post-stroke patients initiated PCSK9-targeted therapy within 24 months. Age- and region-based inequities persist within a universal coverage system. Restrictive reimbursement criteria, mandatory specialist referral requirements, and limited cross-disciplinary pathways represent actionable structural barriers. Systemic reforms targeting prescribing pathways, reimbursement thresholds, and accountability frameworks are required to close the implementation gap in secondary cardiovascular prevention.
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Sedova et al. (2026) conducted a cohort in Incident myocardial infarction or ischemic stroke (n=81,366). PCSK9-targeted therapies (monoclonal antibodies and inclisiran) was evaluated on Initiation of PCSK9-targeted therapy within 24 months (OR 0.47). PCSK9-targeted therapy was initiated within 24 months in only 1.0% of incident MI patients and <1% of ischemic stroke patients, with lower odds at age >=75 years (adjusted OR ~0.47).
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