Hodeda Lital, Eisen Alon, Rotholz Aviad, Kornowski Ran, Gurevitz Chen
Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.
Department of Cardiology, Beilinson campus, Rabin Medical Center, Israel.
Am J Prev Cardiol. 2025 Jun 22;23:101022. doi: 10.1016/j.ajpc.2025.101022. eCollection 2025 Sep.
Proprotein convertase subtilisin/kexin type 9 monoclonal antibodies (PCSK9 mAb) lower low-density lipoprotein cholesterol (LDL-C) levels and reduce atherosclerotic cardiovascular disease (ASCVD). Data regarding sex differences in PCSK9 mAb treatment remain lacking. This study examines sex differences in patients' characteristics, indications, efficacy, and safety of PCSK9 mAb treatment.
Retrospective study based on data from the Preventive Cardiology and Lipids Clinic in Rabin Medical Center on patients prescribed with PCSK9 mAb. Collected data included medical background, medications, indications and laboratory data, analyzed by sex.
246 patients were included (mean age 67y, ASCVD 78.8 %, mean baseline LDL-C 128.2 mg/dL). Women (42 %) prescribed with PCSK9 mAb were older (69y vs. 65y, respectively; < 0.001) and had higher baseline LDL-C (138.9 vs. 117.3 mg/dL; < 0.001) than men. The dominant indication for PCSK9 mAb therapy in both sexes was secondary prevention, however, primary prevention was more prevalent in women (39.4 % vs. 16.3 %, respectively; < 0.001). Overall, high adherence to treatment was observed without sex differences (91.8 % and 79.7 % at 3 and 12 months, respectively). After 1-year, adherent women had higher LDL-C levels than adherent men (61.9 vs. 46.8 mg/dL, respectively; = 0.001), and were less likely to reach their LDL-C goals; >70 mg/dL (62.2 % vs. 76.1 %, respectively; = 0.032) and > 55 mg/dL (39.8 % vs. 60.1 % respectively; = 0.003).
PCSK9 mAbs treatment demonstrated sex differences in prescription age, indications, baseline LDL-C and achievement of LDL-C goals. Adherence to PCSK9 mAb therapy was higher than previously reported, possibly due to careful surveillance strategy in a dedicated prevention clinic.
前蛋白转化酶枯草溶菌素/kexin 9型单克隆抗体（PCSK9 mAb）可降低低密度脂蛋白胆固醇（LDL-C）水平并减少动脉粥样硬化性心血管疾病（ASCVD）。关于PCSK9 mAb治疗中性别差异的数据仍然缺乏。本研究探讨了PCSK9 mAb治疗在患者特征、适应证、疗效和安全性方面的性别差异。
基于拉宾医疗中心预防心脏病学和脂质诊所中接受PCSK9 mAb治疗患者的数据进行回顾性研究。收集的数据包括医学背景、用药情况、适应证和实验室数据，并按性别进行分析。
共纳入246例患者（平均年龄67岁，ASCVD患者占78.8%，平均基线LDL-C为128.2 mg/dL）。接受PCSK9 mAb治疗的女性（占42%）年龄更大（分别为69岁和65岁；P<0.001），且基线LDL-C水平更高（分别为138.9 mg/dL和117.3 mg/dL；P<0.001）。PCSK9 mAb治疗在两性中的主要适应证均为二级预防，然而，一级预防在女性中更为普遍（分别为39.4%和16.3%；P<0.001）。总体而言，观察到治疗依从性较高，且无性别差异（3个月和12个月时分别为91.8%和79.7%）。1年后，依从性好的女性的LDL-C水平高于依从性好的男性（分别为61.9 mg/dL和46.8 mg/dL；P = 0.001），且达到LDL-C目标的可能性较小；LDL-C>70 mg/dL（分别为62.2%和76.1%；P = 0.032）以及LDL-C>55 mg/dL（分别为39.8%和60.1%；P = 0.003）。
PCSK9 mAb治疗在处方年龄、适应证、基线LDL-C和LDL-C目标达成方面存在性别差异。PCSK9 mAb治疗的依从性高于先前报道，这可能归因于在专门的预防诊所采取了仔细的监测策略。
