• Alberto Cordero, Mª Rosa Fernández Olmo, Gustavo A Cortez Quiroga, Cesar Romero-Menor, Lorenzo Fácila, José Seijas-Amigo, Juan Rondán Murillo, Miriam Sandin, Moisés Rodríguez-Mañero, María C Bello Mora, Alfonso Valle, Aisa Fornovi, Roman Freixa Pamias, Jordi Bañeras, Pedro Blanch García, María Milagros Clemente Lorenzo, Sergio Sánchez-Álvarez, Luis López-Rodríguez, and José R González-Juanatey.
• Cardiology Department, Hospital Universitario de San Juan, Alicante, Spain.
• Eur. J. Clin. Invest. 2022 Dec 1; 52 (12): e13863e13863.

BackgroundMonoclonal 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, such as cholesterol remnants or, the so-called lipid residual risk, is unknown.MethodsMulticenter and retrospective registry of patients treated with PCSK9 inhibitors from 14 different hospitals in Spain. Before and on-treatment lipid parameters were recorded. Residual lipid risk was estimated by (1) cholesterol remnants, (2) triglycerides/HDLc ratio (TG/HDL), (3) total cholesterol/HDLc (TC/HDL) and (4) the triglycerides-to-glucose index (TGGi).ResultsSix hundred fifty-two patients were analysed, mean age of 60.2 (9.63) years, 24.69% women and mean LDLc before treatment 149.24 (49.86) mg/dl. Median time to second blood determination was 187.5 days. On-treatment LDLc was 67.46 (45.78) mg/dl, which represented a 55% reduction. Significant reductions were observed for TG/HDL ratio, cholesterol remnants, TC/HDL ratio and TGGi. As consequence, 34.61% patients had LDLc <55 mg/dl and cholesterol remnants <30 mg/dl; additionally, 31.95% had cholesterol remnants <30 mg/dl but LDLc >55 mg/dl. Patients who had levels of cholesterol remnants >30 mg/dl before initiating the treatment with PCSK9 had higher reductions in cholesterol remnants, TG/HDL ratio, TC/HDL and TGGi. By contrast, no reduction differences were observed according to baseline LDLc (< or > the mean), age, gender or obesity.ConclusionsThis 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.© 2022 Stichting European Society for Clinical Investigation Journal Foundation. Published by John Wiley & Sons Ltd.

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