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Which is the optimal choice in lipid-lowering therapy for reducing major cardiovascular events? a network
Qiang Niu1, Qilei Wang1, Feng Chen1
1Department of Cardiology, Zibo Central Hospital, Zibo, China.
Background:
Currently, there are various lipid-lowering therapies in clinical practice, and the emergence of PCSK9 inhibitors has undoubtedly added a valuable tool to lipid-lowering strategies. However, existing studies lack comparisons between different PCSK9 inhibitors and between the outcomes of using PCSK9 inhibitors alone versus in combination with statins. Therefore, this study aims to explore the efficacy and safety of different lipid-lowering regimens, aiming to determine the optimal lipid-lowering regimen.
Methods:
We searched PubMed/Medline and the Cochrane Library of Clinical Trials for related articles published up to October 2024. A network meta-analysis was applied including studies comparing PCSK9 inhibitors with statins or ezetimibe that have MACE outcomes. The efficacy endpoint was MACE, and the safety endpoints were new-onset diabetes and neurocognitive impairment.
Results:
We included a total of 29 studies, comprising 68,686 patients. Compared to oral lipid-lowering drugs, PCSK9 inhibitors combined with statins significantly reduced the incidence of MACE. While, PCSK9 inhibitors alone did not significantly reduce the risk of MACE.
Conclusion:
For patients requiring intensive lipid lowering, the combination of PCSK9 inhibitors with statins provides the greatest clinical benefit. While, for patients with moderate to low risk who need only single-drug therapy, statins are generally preferred over PCSK9 inhibitors considering various factors.
Insights
PCSK9 inhibitors combined with statins significantly reduce major adverse cardiovascular events (MACE) compared to oral drugs. For intensive lipid lowering, this combination offers the most benefit, while statins alone are often preferred for lower-risk patients.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Clinical Trials
Background:
- Lipid-lowering therapies are crucial for cardiovascular health.
- Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors represent a significant advancement.
- Gaps exist in comparing PCSK9 inhibitors and their combination therapies.
Purpose of the Study:
- To compare the efficacy and safety of various lipid-lowering regimens.
- To determine the optimal lipid-lowering strategy.
- To evaluate PCSK9 inhibitors alone versus in combination with statins.
Main Methods:
- Network meta-analysis of randomized controlled trials.
- Searched PubMed/Medline and Cochrane Library up to October 2024.
- Included studies with MACE, new-onset diabetes, and neurocognitive impairment outcomes.
Main Results:
- 29 studies with 68,686 patients were included.
- PCSK9 inhibitors plus statins significantly reduced MACE versus oral drugs.
- PCSK9 inhibitors alone did not significantly reduce MACE risk.
Conclusions:
- Combination therapy (PCSK9 inhibitors + statins) offers maximal benefit for intensive lipid lowering.
- Statins alone are generally preferred for moderate-to-low risk patients needing monotherapy.
- Regimen choice should consider patient risk and therapeutic goals.
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