Effects of Non-statin Lipid-Lowering Therapies Implementation and Statin Treatment Intensification on Lipid Status in...

Statin therapy up-titration is hindered in heart-transplant (HT) recipients due to concern for pharmacological interactions and side effects. Alternative lipid lowering therapies (LLT) are now available for patients who are poorly tolerant to statins or those with significant dyslipidaemia despite maximal dose statin treatment and dietary advice. Real-world studies with non-statin LLT are limited in HT population.

To examine the lipid status of HT patients following the increased adoption of non-statin lipid lowering therapies.

Single centre retrospective observational cohort study including adult HT patients under follow-up in a tertiary centre. From August 2024 to March 2025, 238 patients had lipid profile, prevalence of statin and non-statin LLT prescription assessed and compared to the same data measured in 2019/2020.

Patients had a median age of 64 (IQR=53.3-72.0) years, 27% were female. Median LDL-C levels for paired values significantly decreased from 109.6 [88.9-133.0] to 93.8 [72.5-112.0] at last follow up (p<0.001). The proportion of patients receiving ezetimibe sharply increased [73 (30.7%) compared to 27 (11.3%), p<0.001]; 10 patients (4.2%) were receiving proprotein convertase subtilisin/kexin type 9 inhibitor monoclonal antibodies (PCSK9i), 3 (1.3%) inclisiran, 3 (1.3%) bempedoic acid, which were not commercially available at the time of the previous assessment. Also, the proportion of patients receiving statins increased during follow-up [145 (60.9%) vs 128 (52.1%), p<0.001], mainly because of high-intensity statin adoption.

In a real-world cohort of HT recipients, increased adoption of ezetimibe, PCSK9-targeting therapies and bempedoic acid combined with intensification of statin therapy safely and efficiently reduced LDL-C.