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Impact of a Meds-to-Beds PCSK9i Initiation Program on LDL-C in Patients Undergoing ASCVD Revascularization

Daniel Lorenzatti1, Garred S Greenberg1, Annalisa Filtz1

  • 1Division of Cardiology, Montefiore Health System/Albert Einstein College of Medicine, Bronx, New York, USA.

JACC. Advances
|August 20, 2025
PubMed

Insights

Early use of proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9i) monoclonal antibodies via a meds-to-beds program significantly improved LDL-C goal attainment in patients postrevascularization. This approach enhanced lipid management for secondary cardiovascular disease prevention.

Area of Science:

  • Cardiology
  • Pharmacology
  • Preventive Medicine

Background:

  • Suboptimal low-density lipoprotein cholesterol (LDL-C) goal achievement persists despite established benefits of LDL-C lowering in secondary atherosclerotic cardiovascular disease (ASCVD) prevention.
  • Maximizing lipid-lowering therapy is crucial for reducing recurrent cardiovascular events in high-risk patients.

Purpose of the Study:

  • To evaluate the efficacy of early proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9i) monoclonal antibody (mAb) initiation through a meds-to-beds (M2B) program.
  • To assess if this intervention improves LDL-C goal attainment in patients undergoing revascularization for ASCVD.

Main Methods:

  • A prospective cohort of patients undergoing coronary or peripheral artery revascularization received guideline-recommended PCSK9i mAbs via an M2B program.
  • Patients were on maximally tolerated statin therapy with baseline LDL-C ≥70 mg/dL and followed for at least 6 months.
  • LDL-C goal attainment rates were compared to a directly matched historical control group receiving standard of care.

Main Results:

  • The PCSK9i mAb group (n=72) showed significantly higher LDL-C goal achievement at 6 months (92% <70 mg/dL, 79% <55 mg/dL) compared to controls (40% and 25%, respectively).
  • Median LDL-C reduction was substantially greater in the PCSK9i mAb group (66%) versus the control group (25%).
  • Baseline LDL-C was lower in the PCSK9i mAb group (96 mg/dL) than in controls (109 mg/dL), with P < 0.05.

Conclusions:

  • Early implementation of guideline-recommended PCSK9i mAbs via a dedicated M2B program effectively enhances LDL-C goal attainment.
  • This strategy is beneficial for patients with established ASCVD undergoing revascularization, improving secondary prevention outcomes.
Abstract

Keywords:
ASCVDLDL-CPCSK9 inhibitorsmeds-to-bedsnon–HDL-C

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