Repositori Digital de la UPF
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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.
(Elsevier, 2023)