Abstract
BACKGROUND: Despite proven benefits of low-density lipoprotein cholesterol (LDL-C) lowering in secondary prevention of atherosclerotic cardiovascular disease, goal achievement remains suboptimal. OBJECTIVES: The authors tested whether early use of guideline-recommended proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9i) monoclonal antibodies (mAbs) through a meds-to-beds (M2B) program improved LDL-C goal attainment postrevascularization. METHODS: Using a dedicated M2B program, we prospectively included patients undergoing coronary or peripheral artery revascularization, on maximally tolerated statin therapy, and with LDL-C ≥70 mg/dL. Patients received support to start PCSK9i mAbs and were followed for at least 6 months. LDL-C goal attainment rates were compared with standard of care using a direct-matched retrospective cohort. Statistical comparisons were made with chi-squared, Wilcoxon rank sum, and t-tests, as appropriate. RESULTS: The 72 patients in the prospective PCSK9i mAb cohort (median age 66 years, 38% women, 57% Hispanic) were matched to 136 historical controls. Baseline median LDL-C was 96 mg/dL (IQR: 80, 122) in the PCSK9i mAb group and 109 mg/dL (IQR: 87, 137) in the control group (P < 0.05). At 6 months, LDL-C goal achievement was greater in the PCSK9i mAb group (92% achieved LDL-C <70 mg/dL and 79% achieved LDL-C <55 mg/dL) than in the control group (40% and 25%, respectively) (P < 0.001 for both). A larger median percent reduction in LDL-C was also observed in the PCSK9i mAb group than in the historical control group (66% vs 25%; P < 0.001). CONCLUSIONS: Early initiation of guideline-recommended PCSK9i mAbs through a dedicated M2B program was associated with enhanced attainment of LDL-C goals in patients with established atherosclerotic cardiovascular disease undergoing revascularization.