PCSK9 inhibition
PCSK9 inhibitors cut MACE risk by 13% while lowering Lp(a) alongside LDL-C, meta-analysis of 12 RCTs and 48,116 coronary patients finds (Coron Artery Dis 2025)
Original title: Effect of PCSK9 inhibitors on major cardiac adverse events and lipoprotein-a in patients with coronary heart disease: a meta-analysis
This meta-analysis pooled 12 randomised controlled trials with 48,116 patients with coronary heart disease (mean age 62, 65% male, diverse ethnic backgrounds) to evaluate PCSK9 inhibitors' effects on lipids and major adverse cardiac events (MACE). Compared with controls, PCSK9 inhibitors significantly reduced LDL-C (weighted mean difference -1.24 mmol/L, 95% CI -1.28 to -1.20), total cholesterol, triglycerides and Lp(a), while raising HDL-C, with no increased risk of adverse reactions beyond injection-site reactions. For MACE, PCSK9 inhibitors significantly reduced the composite risk of nonfatal myocardial infarction, stroke and coronary revascularisation (RR 0.87, 95% CI 0.84-0.89). The authors conclude PCSK9 inhibitors improve lipid profiles, lower Lp(a), and reduce MACE risk, offering an effective and safe treatment option for patients with coronary heart disease.
Original abstract
Background: Lipoprotein(a) [Lp(a)] is an independent risk factor for cardiovascular disease due to its unique apo(a) component and its association with atherosclerosis and thrombogenesis. This meta-analysis was conducted to evaluate the effects of PCSK9 inhibitors on major adverse cardiac events (MACE) and Lp(a) levels in patients with coronary heart disease.
Methods: Randomized controlled trials (RCTs) were systematically searched in PubMed, the Cochrane Library, and other databases. Stata 15.1 software was used for data analysis, and a random- or fixed-effects model was selected based on inter-study heterogeneity. Egger's test was applied to detect publication bias.
Results: A total of 12 RCTs were included, involving 48 116 patients with a mean age of 62 years, comprising 65% males and diverse ethnic backgrounds. The results showed that compared with the control group, PCSK9 inhibitors significantly reduced low-density lipoprotein cholesterol (WMD = -1.24 mmol/L, 95% confidence interval (CI): -1.28 to -1.20), total cholesterol, triglycerides, and Lp(a) levels while increasing high-density lipoprotein cholesterol levels. In terms of safety, there was no increased risk of adverse reactions other than injection site reactions. For MACE, PCSK9 inhibitors significantly reduced the risk of nonfatal myocardial infarction, stroke, and coronary revascularization events (RR = 0.87, 95% CI: 0.84-0.89).
Conclusion: PCSK9 inhibitors not only significantly improve blood lipid profiles and reduce Lp(a) levels but also reduce the risk of MACE in patients with coronary heart disease. Therefore, PCSK9 inhibitors offer an effective and safe treatment option for these patients.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 17 August 2026. Methods.