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Updated: Jun 20, 2025
Measuring the Carotid to Femoral Pulse Wave Velocity Cf-PWV to Evaluate Arterial Stiffness
Published on: May 3, 2018
Effect of adding PCSK9 inhibitors to lipid-lowering interventions on arterial stiffness: A systematic review and
I Cavero-Redondo1,2, N Moreno-Herraiz1, A Del Saz-Lara1,3,4
1CarVasCare Research Group (2023-GRIN-34459), Faculta de Enfermería de Cuenca, Universidad de Castilla-La Mancha, Cuenca, Spain.
Insights
Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) significantly improve arterial stiffness beyond lowering LDL-C. This finding suggests broader vascular benefits for cardiovascular health.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Vascular Biology
Background:
- Atherosclerosis management requires controlling hypercholesterolemia, particularly elevated LDL-C.
- Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) have revolutionized lipid-lowering therapies.
- Potential pleiotropic effects of PCSK9i on arterial health, beyond lipid reduction, warrant investigation.
Purpose of the Study:
- To systematically review and meta-analyze the effects of PCSK9i on arterial stiffness.
- To assess the impact of PCSK9i on vascular health beyond traditional lipid-lowering metrics.
- To contribute to a comprehensive understanding of cardiovascular risk reduction strategies.
Main Methods:
- Systematic literature search across databases, trial registries, and grey literature.
- Inclusion of prospective cohort studies on adults receiving PCSK9i therapy.
- Analysis of arterial stiffness measured by pulse wave velocity (PWv) using random-effects meta-analyses and meta-regression.
Main Results:
- Five studies with 158 participants met the criteria.
- A significant reduction in PWv was observed with PCSK9i addition (mean difference: -2.61 m/s).
- Subgroup analyses indicated potential variations based on sex and baseline PWv.
Conclusions:
- Adding PCSK9i to lipid-lowering interventions significantly improves arterial stiffness.
- PCSK9i demonstrate vascular benefits extending beyond LDL-C reduction.
- Findings support a broader role for PCSK9i in cardiovascular risk management.
Background:
Atherosclerosis, a leading cause of mortality, necessitates effective management of hypercholesterolemia, specifically elevated low-density lipoprotein cholesterol (LDL-C). The emergence of proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) has revolutionised lipid-lowering. PCSK9i demonstrates substantial LDL-C reduction and cardiovascular benefits, particularly in statin-intolerant or nonresponsive individuals. However, the potential pleiotropic effects of PCSK9i, especially on arterial stiffness, remain a subject of investigation. This systematic review and meta-analysis seek to provide a nuanced understanding of the potential pleiotropic effects of PCSK9i, specifically on arterial health. The primary objective was to analyse the influence of PCSK9i on arterial stiffness, extending beyond traditional lipid-lowering metrics and contributing to a more comprehensive approach to cardiovascular risk reduction.
Methods:
A systematic search was conducted across major databases, clinical trial registries and grey literature. Inclusion criteria comprised adults in prospective cohort studies undergoing PCSK9i augmentation in lipid-lowering therapy, with a focus on arterial stiffness measured by pulse wave velocity (PWv). Random-effects meta-analyses, sensitivity analyses and meta-regression models were employed to assess the pooled effect of adding PCSK9i to lipid-lowering interventions on arterial stiffness.
Results:
Five studies (158 participants) met the inclusion criteria, demonstrating a significant reduction in PWv (mean difference: -2.61 m/s [95% CI: -3.70, -1.52]; ES: -1.62 [95% CI: -2.53, -.71]) upon adding PCSK9i to lipid-lowering interventions. Subgroup analysis and meta-regression models suggested potential sex-based and baseline PWv-dependent variations, emphasising patient-specific characteristics.
Conclusion:
The meta-analysis provides robust evidence that adding PCSK9i to lipid-lowering interventions significantly improves arterial stiffness, indicating broader vascular benefits beyond LDL-C reduction.
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