Lorenzatti Daniel, Greenberg Garred S, Filtz Annalisa, Scotti Andrea, Jaspan Vita N, Park Christine M, Kalich Bethany, Jones Laney K, Kathe Niranjan, Di Palo Katherine E, Browne Constance, Lipsitz Evan, Forest Stephen J, Latib Azeem, Garcia Mario J, Rodriguez Carlos J, Shapiro Michael D, Gulati Martha, Slipczuk Leandro
Division of Cardiology, Montefiore Health System/Albert Einstein College of Medicine, Bronx, New York, USA.
Amgen Inc, Thousand Oaks, California, USA.
JACC Adv. 2025 Aug 19;4(9):102075. doi: 10.1016/j.jacadv.2025.102075.
Despite proven benefits of low-density lipoprotein cholesterol (LDL-C) lowering in secondary prevention of atherosclerotic cardiovascular disease, goal achievement remains suboptimal.
The authors tested whether early use of guideline-recommended proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9i) monoclonal antibodies (mAbs) through a meds-to-beds (M2B) program improved LDL-C goal attainment postrevascularization.
Using a dedicated M2B program, we prospectively included patients undergoing coronary or peripheral artery revascularization, on maximally tolerated statin therapy, and with LDL-C ≥70 mg/dL. Patients received support to start PCSK9i mAbs and were followed for at least 6 months. LDL-C goal attainment rates were compared with standard of care using a direct-matched retrospective cohort. Statistical comparisons were made with chi-squared, Wilcoxon rank sum, and t-tests, as appropriate.
The 72 patients in the prospective PCSK9i mAb cohort (median age 66 years, 38% women, 57% Hispanic) were matched to 136 historical controls. Baseline median LDL-C was 96 mg/dL (IQR: 80, 122) in the PCSK9i mAb group and 109 mg/dL (IQR: 87, 137) in the control group (P < 0.05). At 6 months, LDL-C goal achievement was greater in the PCSK9i mAb group (92% achieved LDL-C <70 mg/dL and 79% achieved LDL-C <55 mg/dL) than in the control group (40% and 25%, respectively) (P < 0.001 for both). A larger median percent reduction in LDL-C was also observed in the PCSK9i mAb group than in the historical control group (66% vs 25%; P < 0.001).
Early initiation of guideline-recommended PCSK9i mAbs through a dedicated M2B program was associated with enhanced attainment of LDL-C goals in patients with established atherosclerotic cardiovascular disease undergoing revascularization.
尽管低密度脂蛋白胆固醇（LDL-C）降低在动脉粥样硬化性心血管疾病二级预防中已证实有益，但目标达成情况仍不尽人意。
作者测试了通过药物到病床（M2B）计划早期使用指南推荐的前蛋白转化酶枯草溶菌素/kexin 9型抑制剂（PCSK9i）单克隆抗体（mAb）是否能改善血管重建术后LDL-C目标达成情况。
利用专门的M2B计划，我们前瞻性纳入了接受冠状动脉或外周动脉血管重建、接受最大耐受剂量他汀类药物治疗且LDL-C≥70mg/dL的患者。患者在启动PCSK9i mAb时获得支持，并随访至少6个月。使用直接匹配的回顾性队列将LDL-C目标达成率与标准治疗进行比较。根据情况使用卡方检验、Wilcoxon秩和检验和t检验进行统计比较。
前瞻性PCSK9i mAb队列中的72例患者（中位年龄66岁，38%为女性，57%为西班牙裔）与136例历史对照匹配。PCSK9i mAb组的基线中位LDL-C为96mg/dL（四分位间距：80，122），对照组为109mg/dL（四分位间距：87，137）（P<0.05）。在6个月时，PCSK9i mAb组的LDL-C目标达成情况优于对照组（92%的患者LDL-C<70mg/dL，79%的患者LDL-C<55mg/dL，而对照组分别为40%和25%）（两者P<0.001）。PCSK9i mAb组的LDL-C中位数降低百分比也高于历史对照组（66%对25%；P<0.001）。
通过专门的M2B计划早期启动指南推荐的PCSK9i mAb与接受血管重建的已确诊动脉粥样硬化性心血管疾病患者LDL-C目标达成情况的改善相关。
