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Journal of Diabetes & Metabolic Disorders

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01-12-2020 | Stroke | Research article

Prevention of myocardial infarction and stroke with PCSK9 inhibitors treatment: a metanalysis of recent randomized clinical trials

Authors: Alberto Cordero, Moisés Rodríguez-Mañero, Lorenzo Fácila, M. Rosa Fernández-Olmo, Manuel J. Gómez-Martínez, Alfonso Valle, Jose Mª Castellano, Miriam Martín Toro, José Seijas-Amigo, Alvaro Vicedo, José R. González-Juanatey

Published in: Journal of Diabetes & Metabolic Disorders | Issue 2/2020

Abstract

Purpose

Proprotein convertase subtilisin/kexin 9 (PCSK9) inhibitors treatment induce large reductions in low-density lipoprotein cholesterol (LDLc) and major cardiovascular events. Clinical trials might have been underpowered to test the effect of PSCK9 inhibitors treatment on myocardial infarction and stroke, two of the most relevant cardiovascular events, since all analyzed a combined endpoint.

Methods

we performed a meta-analysis, with currently available studies involving PCSK9 inhibitors and event rate adjudication, with the aim of assessing treatment effects on myocardial infarction and stroke.

Results

We included 81,700 patients, 41,979 treated with a PSCK9 inhibitors: 17,244 with evolocumab; 13,720 with bococizumab and 11,015 with alirocumab. A total of 1,319 cases of myocardial infarctions were registered in the treatment group vs. 1,608 in controls, resulting in 19.0% reduction associated with PCSK9 treatment (RR: 0.81, 95% CI 0.76–0.87). Similarly, PCSK9 inhibitors treatment resulted in a 25% reduction of stroke (RR: 0.75, 95% CI 0.65–0.85) when all studies were analyzed together and the statistically significant heterogeneity was not observed in the analysis restricted to end-point based clinical trials. PCSK9 inhibitors treatment had no effect on mortality (RR: 0.95, 95% CI 0.86–1.04).

Conclusions

PCSK9 inhibitors reduce the incidence of myocardial infarction by 19% and stroke by 25%.

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Title: Prevention of myocardial infarction and stroke with PCSK9 inhibitors treatment: a metanalysis of recent randomized clinical trials
Authors: Alberto Cordero
Moisés Rodríguez-Mañero
Lorenzo Fácila
M. Rosa Fernández-Olmo
Manuel J. Gómez-Martínez
Alfonso Valle
Jose Mª Castellano
Miriam Martín Toro
José Seijas-Amigo
Alvaro Vicedo
José R. González-Juanatey
Publication date: 01-12-2020
Publisher: Springer International Publishing
Keywords: Stroke
PCSK9 Inhibitor
Myocardial Infarction
Evolocumab
Ezetimibe
Alirocumab
Published in: Journal of Diabetes & Metabolic Disorders / Issue 2/2020
Electronic ISSN: 2251-6581
DOI: https://doi.org/10.1007/s40200-020-00557-6

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