The efficacy of PCSK9 inhibitors on major cardiovascular events and lipid profile in patients with diabetes: a systematic review and meta-analysis of randomized controlled trials
- PMID: 36972610
- DOI: 10.1093/ehjcvp/pvad019
The efficacy of PCSK9 inhibitors on major cardiovascular events and lipid profile in patients with diabetes: a systematic review and meta-analysis of randomized controlled trials
Abstract
Objective: To evaluate the specific effects of PCSK9 inhibitors (i.e. alirocumab and evolocumab) on major cardiovascular events (MACE) and lipid profile in patients with diabetes.
Methods and results: We conducted a systematic review of literature according to the PRISMA statement. A total of eight randomized control trials (RCTs) enrolling 20 651 patients with diabetes were included. The mean follow-up was 51 weeks. We included RCTs that had compared the subtilisin-kexin type 9 inhibitors (PCSK9i) alirocumab and evolocumab with placebo in subjects with hypercholesterolaemia and diabetes mellitus.MACE occurred in 8.7% of patients with diabetes randomized to PCSK9i vs. 11.0% of those randomized to placebo. Thus, the use of alirocumab or evolocumab reduced MACE by 18% [odds ratio (OR): 0.82; 95% confidence interval (CI): 0.74-0.90]. Compared with control group, the use of PCSK9 inhibitors was associated with a significant percentage change from baseline in low-density lipoprotein cholesterol [mean difference (MD) -58.48%; 95% CI: -63.73 to -53.22%, P < 0.0001], high-density lipoprotein cholesterol (HDL-C) (MD 5.21%; 95% CI: 3.26-7.17%), triglycerides (MD -14.59%; 95% CI: -19.42 to -9.76%), non-HDL-C (MD -48.84%; 95% CI: -54.54 to -43.14%), and total cholesterol (MD -33.76%; 95% CI: -38.71 to -28.8%). Moreover, a significant reduction of lipoprotein(a) (MD -32.90%; 95% CI: -38.55 to -27.24%) and apolipoprotein B (MD -46.83%; 95% CI: -52.71 to --40.94%) were observed in PCSK9i group compared with placebo.
Conclusion: PCSK9i appear to be effective in reducing the risk of MACE and in improving lipid profiles of subjects with diabetes and dyslipidaemia.
Keywords: Diabetes; Lipid profile; Major cardiovascular events; PCSK9 inhibitors.
© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.
Similar articles
-
Efficacy and Safety of PCSK9 Monoclonal Antibodies in Patients at High Cardiovascular Risk: An Updated Systematic Review and Meta-Analysis of 32 Randomized Controlled Trials.Adv Ther. 2020 Apr;37(4):1496-1521. doi: 10.1007/s12325-020-01259-4. Epub 2020 Feb 27. Adv Ther. 2020. PMID: 32108309
-
Proprotein convertase subtilisn/kexin type 9 inhibitors and small interfering RNA therapy for cardiovascular risk reduction: A systematic review and meta-analysis.PLoS One. 2023 Dec 6;18(12):e0295359. doi: 10.1371/journal.pone.0295359. eCollection 2023. PLoS One. 2023. PMID: 38055686 Free PMC article.
-
Safety profile of proprotein convertase subtilisin/kexin type 9 inhibitors alirocumab and evolocumab: an updated meta-analysis and meta-regression.Curr Med Res Opin. 2024 Jul;40(7):1103-1121. doi: 10.1080/03007995.2024.2363971. Epub 2024 Jun 11. Curr Med Res Opin. 2024. PMID: 38836510
-
Efficacy of Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitors in Patients with Heterozygous Familial Hypercholesterolemia: A Meta-analysis.Am J Cardiovasc Drugs. 2025 Jan;25(1):47-55. doi: 10.1007/s40256-024-00682-0. Epub 2024 Sep 20. Am J Cardiovasc Drugs. 2025. PMID: 39304616
-
Impact of alirocumab/evolocumab on lipoprotein (a) concentrations in patients with familial hypercholesterolaemia: a systematic review and meta-analysis of randomized controlled trials.Endokrynol Pol. 2023;74(3):234-242. doi: 10.5603/EP.a2023.0036. Epub 2023 Jun 19. Endokrynol Pol. 2023. PMID: 37335067
Cited by
-
Lipid abnormality in diabetic kidney disease and potential treatment advancements.Front Endocrinol (Lausanne). 2025 Mar 18;16:1503711. doi: 10.3389/fendo.2025.1503711. eCollection 2025. Front Endocrinol (Lausanne). 2025. PMID: 40171201 Free PMC article. Review.
-
Management of dyslipidaemia in patients with comorbidities-facing the challenge.Eur Heart J Cardiovasc Pharmacother. 2025 Mar 13;11(2):164-173. doi: 10.1093/ehjcvp/pvae095. Eur Heart J Cardiovasc Pharmacother. 2025. PMID: 39719399 Free PMC article. Review.
-
Prevention is the key.Eur Heart J Cardiovasc Pharmacother. 2025 Jan 11;10(8):649-651. doi: 10.1093/ehjcvp/pvae090. Eur Heart J Cardiovasc Pharmacother. 2025. PMID: 39797531 Free PMC article. No abstract available.
-
Emerging Biomarkers and Determinants of Lipoprotein Profiles to Predict CVD Risk: Implications for Precision Nutrition.Nutrients. 2024 Dec 27;17(1):42. doi: 10.3390/nu17010042. Nutrients. 2024. PMID: 39796476 Free PMC article. Review.
-
Circulating PCSK9 as a prognostic biomarker of cardiovascular events in individuals with type 2 diabetes: evidence from a 16.8-year follow-up study.Cardiovasc Diabetol. 2023 Aug 24;22(1):222. doi: 10.1186/s12933-023-01948-8. Cardiovasc Diabetol. 2023. PMID: 37620933 Free PMC article.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Medical
Miscellaneous