TY - JOUR
T1 - Sex Differences in Cardiovascular Outcomes and Cholesterol-Lowering Efficacy of PCSK9 Inhibitors
T2 - Systematic Review and Meta-Analysis
AU - Rivera, Frederick Berro
AU - Cha, Sung Whoy
AU - Aparece, John Paul
AU - Rocimo, Aubrey
AU - Ong, Bradley Ashley
AU - Golbin, Jem Marie
AU - Alfonso, Pia Gabrielle
AU - Enkhmaa, Byambaa
AU - Khan, Safi U.
AU - Cainzos-Achirica, Miguel
AU - Volgman, Annabelle Santos
AU - Navar, Ann Marie
AU - Shah, Nishant P.
N1 - Publisher Copyright:
© 2023 The Authors
PY - 2023/11
Y1 - 2023/11
N2 - Background: Guideline-recommended low-density lipoprotein cholesterol (LDL-C) thresholds are often not achieved in women. The proprotein convertase subtilisin/kexin type-9 inhibitor (PCSK9i) monoclonal antibodies can help further reduce LDL-C and major adverse cardiovascular events (MACE) although differences in efficacy by sex and type are less understood. Objectives: The authors sought to determine if there are differences in the efficacy of LDL-C lowering and reduction in the risk of MACE by sex and type of PCSK9i. Methods: A comprehensive literature search was done through October 17, 2022, for published trials comparing PCSK9i vs control. Outcomes assessed were LDL-C reduction and incidence of MACE following the use of PCSK9i vs placebo, stratified by sex and type of PCSK9i used. Results: We identified 16 trials with 54,996 adults, and 15,143 (27.5%) of them were female. PCSK9i significantly reduced MACE compared to placebo in both women (HR: 0.86, 95% CI: 0.74-0.97, P < 0.001) and men (HR: 0.85, 95% CI: 0.79-0.91, P < 0.001) with no significant sex difference (MD −0.01, 95% CI: −0.14 to −0.13, P = 0.930). PCSK9i also significantly reduced LDL-C levels in both sexes at 12 weeks (females: MD −62.57, 95% CI: −70.24 to −54.91, P < 0.001; males: MD −66.19, 95% CI: −72.03 to −60.34, P < 0.001) and 24 weeks (females: MD −47.52, 95% CI: −52.94 to −42.09, P < 0.001; males: MD −54.07, 95% CI: −59.46 to −48.68, P < 0.001). Significant sex difference was seen in the LDL reduction of PCSK9i for both 12 weeks (males vs females: MD −4.55, 95% CI: −7.34 to −1.75, P < 0.01) and 24 weeks (males vs females: MD −7.11, 95% CI: −9.99 to −4.23, P < 0.001). Conclusions: The use of PCSK9i results in significant LDL-C and MACE reduction in both males and females. While there is no significant sex difference in MACE reduction, LDL-C reduction is greater in males than in females. Our data support the equal use of PCSK9i in all eligible patients, regardless of sex.
AB - Background: Guideline-recommended low-density lipoprotein cholesterol (LDL-C) thresholds are often not achieved in women. The proprotein convertase subtilisin/kexin type-9 inhibitor (PCSK9i) monoclonal antibodies can help further reduce LDL-C and major adverse cardiovascular events (MACE) although differences in efficacy by sex and type are less understood. Objectives: The authors sought to determine if there are differences in the efficacy of LDL-C lowering and reduction in the risk of MACE by sex and type of PCSK9i. Methods: A comprehensive literature search was done through October 17, 2022, for published trials comparing PCSK9i vs control. Outcomes assessed were LDL-C reduction and incidence of MACE following the use of PCSK9i vs placebo, stratified by sex and type of PCSK9i used. Results: We identified 16 trials with 54,996 adults, and 15,143 (27.5%) of them were female. PCSK9i significantly reduced MACE compared to placebo in both women (HR: 0.86, 95% CI: 0.74-0.97, P < 0.001) and men (HR: 0.85, 95% CI: 0.79-0.91, P < 0.001) with no significant sex difference (MD −0.01, 95% CI: −0.14 to −0.13, P = 0.930). PCSK9i also significantly reduced LDL-C levels in both sexes at 12 weeks (females: MD −62.57, 95% CI: −70.24 to −54.91, P < 0.001; males: MD −66.19, 95% CI: −72.03 to −60.34, P < 0.001) and 24 weeks (females: MD −47.52, 95% CI: −52.94 to −42.09, P < 0.001; males: MD −54.07, 95% CI: −59.46 to −48.68, P < 0.001). Significant sex difference was seen in the LDL reduction of PCSK9i for both 12 weeks (males vs females: MD −4.55, 95% CI: −7.34 to −1.75, P < 0.01) and 24 weeks (males vs females: MD −7.11, 95% CI: −9.99 to −4.23, P < 0.001). Conclusions: The use of PCSK9i results in significant LDL-C and MACE reduction in both males and females. While there is no significant sex difference in MACE reduction, LDL-C reduction is greater in males than in females. Our data support the equal use of PCSK9i in all eligible patients, regardless of sex.
KW - PCSK9 inhibitors
KW - cardiovascular events
KW - sex difference
KW - tertiary prevention
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U2 - 10.1016/j.jacadv.2023.100669
DO - 10.1016/j.jacadv.2023.100669
M3 - Article
AN - SCOPUS:85180472496
SN - 2772-963X
VL - 2
JO - JACC: Advances
JF - JACC: Advances
IS - 9
M1 - 100669
ER -