Sex Differences in Cardiovascular Outcomes and Cholesterol-Lowering Efficacy of PCSK9 Inhibitors: Systematic Review and Meta-Analysis
Authors' conclusion
The use of PCSK9i results in significant LDL-C and MACE reduction in both males and females. While there is no significant sex difference in MACE reduction, LDL-C reduction is greater in males than in females.
Study context
- Population
- Adults in trials comparing PCSK9i vs control; 15,143 (27.5%) female
- Participants
- 54,996 adults16 trials
- Comparison
- PCSK9i vs placebo, stratified by sex
- Outcome
- Low-density lipoprotein cholesterol (LDL-C) reduction and incidence of major adverse cardiovascular events (MACE), by sex
Pooled result
As reported in the abstract
MACE, by sex
Hazard ratio (95% CI)P value
PCSK9ivs Placebowomen
0.86(0.74–0.97)
P < 0.001PCSK9ivs Placebomen
0.85(0.79–0.91)
P < 0.001- Sex difference · no significant sex difference
- MD −0.01 (95% CI −0.14 to −0.13); P = 0.930
Further pooled results
| Outcome | MD (95% CI) | P value | |
|---|---|---|---|
| LDL-C reduction, by sex · 12 weeksPCSK9ivs PlaceboFemales | −62.57 (−70.24 to −54.91) | P < 0.001 | |
| LDL-C reduction, by sex · 12 weeksPCSK9ivs PlaceboMales | −66.19 (−72.03 to −60.34) | P < 0.001 | |
| LDL-C reduction, by sex · 12 weeksMalesvs FemalesSex difference | −4.55 (−7.34 to −1.75) | P < 0.01 | |
| LDL-C reduction, by sex · 24 weeksPCSK9ivs PlaceboFemales | −47.52 (−52.94 to −42.09) | P < 0.001 | |
| LDL-C reduction, by sex · 24 weeksPCSK9ivs PlaceboMales | −54.07 (−59.46 to −48.68) | P < 0.001 | |
| LDL-C reduction, by sex · 24 weeksMalesvs FemalesSex difference | −7.11 (−9.99 to −4.23) | P < 0.001 | |
| −100−50050Difference (linear scale) |
Original publication
Sex Differences in Cardiovascular Outcomes and Cholesterol-Lowering Efficacy of PCSK9 Inhibitors: Systematic Review and Meta-Analysis. JACC Adv. Published 28 October 2023. doi:10.
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