Effect of adding PCSK9 inhibitors to lipid‐lowering interventions on arterial stiffness: A systematic review and meta‐analysis

Abstract

AbstractBackgroundAtherosclerosis, 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.MethodsA 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.ResultsFive 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.ConclusionThe meta‐analysis provides robust evidence that adding PCSK9i to lipid‐lowering interventions significantly improves arterial stiffness, indicating broader vascular benefits beyond LDL‐C reduction.