Background Monoclonal antibodies that inhibit the proprotein convertase subtilisin/kexin type 9 (PCSK9) reduce low-density lipoprotein cholesterol (LDLc) by 55%, regardless of baseline treatments. Nonetheless, the effect of other lipid parameters, as cholesterol remnants or, the so-called residual lipid risk, are unknown. Methods Multicenter and retrospective registry of patients treated with PCSK9 inhibitors from 14 different hospitals from Spain. Before and on-treatment lipid parameters were recorded. Cholesterol remnants were calculated by the equation: total cholesterol minus LDLc minus HDLc and values ≥30 were considered high. Residual lipid risk was estimated by 1) the estimation of LDL particle size, by the triglycerides/HDLc ratio (TG/HDL) and values <2 were assumed as low and dense LDL particles; 2) total cholesterol/HDLc (TC/HDL) and values >3 were considered high; and; 3) the triglycerides-to-glucose (TG/Gluc) index, obtained as the natural logarithm of (triglycerides * glucose/2) Results A total of 652 patients were analyzed, mean age 60.0 (10.5) years and 161 (24.69%) women. Baseline LDLc was 149.2 (49.9) mg/dl, cholesterol remnants 29.9 (20.3) mg/dl, TG/HDL 3.9 (4.1), TC/HDL 4.9 (1.9) and TG/Gluc index 8.9 (0.7). Most patients (92.3%) were on statins; 54.8% with ezetimibe, 8.5% with fibrates. Evolocumab was initiated in 318 (56.6%) patients; 229 (40.7%) alirocumab 75 mg and 15 (2.7%) alirocumab 150 mg. Median time to second blood determination were 187.5 (IQR 101–242) days. Mean on-treatment LDLc was 67.46 (45.78) mg/dl what represented a 55% reduction. As shown in the figure, significant reduction in cholesterol remnants (p=0.017), TG/HDL ratio (p=0.020), TC/HDL ratio (p<0.001) and TG/Gluc index (p<0.001). The percentage of patients with remnants >30 mg/dl decreased: 34.62% to 30.07 (p<0.01). Significant reductions were also observed in the percentage of patients with TG/HDL >2 (71.25% to 61.98%; p<0.01) or TC/HDL >3 (94.28% to 38.97%; p<0.01) Conclusions This multicenter and retrospective registry of real-world patients treated with PCSK9 inhibitors demonstrates a positive effect on cholesterol remnants and lipid-residual risk beyond LDLc reductions. Funding Acknowledgement Type of funding sources: None.
Funding Acknowledgements Type of funding sources: None. Main funding source(s): Ninguna. Introduction Cardiovascular disease is the main cause of morbidity and mortality worldwide, but there are inequalities in diagnosis and treatment between men and women. Although there is greater awareness of cardiovascular disease in women, diagnostic techniques are less used in women, they receive fewer pharmacological and invasive treatments, and have less access to cardiac rehabilitation. Objective To compare the assistance offered to men and women in our Cardiac Rehabilitation Unit up to 2018 with the assistance given from 2019 to 2022. Methods Patients treated in the Cardiac Rehabilitation Unit before 2018 (group 1) and from 2019 to 2022 (group 2) were analyzed, comparing the characteristics of male and female patients, as well as the attendance rate to Cardiac Rehabilitation and treatments indicated. Results In group 1, we analyzed the data of 399 patients, 19.8% women. In group 2, which included 167 patients, the rate of women rose to 26.3%, this difference being statistically significant (p<0. 05). Women were older than men in both groups (63 vs 59 years in group 1; 64 vs 59 years in group 2), less smokers (26.3% vs 57.3% in group 1; 25% vs 50.4% in group 2). The percentage of hypertensive patients was the same in both sexes in group 2. Until 2018, fewer coronary angiographies were performed on women (94% vs 99%, p<0.05); however, in the second period (group 2, 2019-2022), the percentage was similar in both sexes, (96% vs 98%, p= n.s.). Revascularization is less, possibly due to the characteristics of coronary disease in women (Table 1). Lipid-lowering treatments are used equally in both groups (Table 1). Conclusion In recent years, care for cardiovascular disease in women has been improving. The percentage of women who are included in Cardiac Rehabilitation program and who undergo coronary angiography has increased. The raising awareness that this disease has the same severity in both sexes has allowed the optimal medical treatment implemented to be similar.
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