# PCSK9-remmers verlagen events bij ASCVD zónder eerder infarct of beroerte (real-world)

*geplaatst 2026-07-13 · Algemeen · European heart journal · doi 10.1093/eurheartj/ehag176 · https://hartvaat.nl/2026/04/16/pcsk9-remmers-verlagen-events-bij-ascvd-zonder-eerder-infarct-of-beroerte-real-w/*

Deze real-world studie (Optum-database, 19.670 patiënten met atherosclerotische hart- en vaatziekte zonder eerder ischemisch event) vergeleek starters van een PCSK9-antistof met gematchte niet-starters. Over vijf jaar was het gecombineerde risico op niet-fataal infarct, niet-fataal herseninfarct of overlijden lager met een PCSK9-remmer (17,5% versus 25,4%): een relatieve risicoreductie van 31% en een absolute reductie van 7,8%. Het LDL-cholesterol daalde gemiddeld 54% (van 118 naar 55 mg/dl). De data ondersteunen vroege, intensieve LDL-verlaging, ook vóór een eerste event.

## English: PCSK9 inhibitor treatment and outcomes in patients with atherosclerotic cardiovascular disease but without prior ischaemic events: an observational study.

This real-world study (Optum database; 19,670 patients with atherosclerotic cardiovascular disease and no prior ischaemic event) compared PCSK9 monoclonal-antibody initiators with matched non-initiators. Over five years, the composite of non-fatal myocardial infarction, non-fatal ischaemic stroke or death was lower with a PCSK9 inhibitor (17.5% vs 25.4%): a 31% relative and 7.8% absolute risk reduction. LDL cholesterol fell by a mean of 54% (from 118 to 55 mg/dL). The data support early, intensive LDL lowering even before a first event.

## Abstract (original, from the publication)

BACKGROUND AND AIMS: Low-density lipoprotein cholesterol (LDL-C)-lowering therapies are proven effective in atherosclerotic cardiovascular disease (ASCVD), but real-world evidence for proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9i) monoclonal antibodies (mAb) remains limited. This study evaluated their impact in patients with ASCVD without prior ischaemic events. METHODS: Patients initiating PCSK9i mAb from January 2016 to December 2022 were identified in the Optum Research Database. A 1:2 propensity score-matched comparator cohort of PCSK9i non-initiators was developed. The primary endpoint was a composite of non-fatal myocardial infarction, non-fatal ischaemic stroke, or all-cause mortality. Key outcomes from the parametric G-formula were 5-year event rates, relative risk reduction (RRR) and absolute risk reduction (ARR), with intention-to-treat (ITT) analysis. Additional outcomes for PCSK9i mAb initiators included absolute and percent LDL-C reduction from baseline. RESULTS: Overall, 19 670 patients met selection criteria (6545 PCSK9i mAb initiators; 13 125 non-initiators). Baseline characteristics were well-balanced. Under ITT, estimated 5-year event rates were 17.5% [95% confidence interval (CI) 15.5%, 19.5%] with PCSK9i mAb vs 25.4% (95% CI 23.6%, 27.1%) without PCSK9i, yielding a RRR of 30.9% and ARR of 7.8%. Individual endpoints showed RRRs of 28.3% for myocardial infarction (P < .0001), 26.4% for ischaemic stroke (P = .02), and 28.5% for all-cause mortality (P < .0001). Among initiators, mean baseline and follow-up LDL-C were 117.8 and 54.7 mg/dL (on-treatment analysis), respectively, representing an absolute reduction of 63.1 mg/dL and percent reduction of 53.6%. CONCLUSIONS: In ASCVD patients without prior events in clinical practice, PCSK9i mAb treatment was associated with lower ischaemic event and mortality rates.

Auteurs: Deepak L Bhatt, Pasquale Perrone Filardi, Irfan Khan, José Tuñón, Nikolaus Marx, Manuel Castro Cabezas, Katherine Andrade, Alexandra Koumas, Zhouyang Lou, Lale Tokgözoğlu

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Bron: European heart journal, https://doi.org/10.1093/eurheartj/ehag176. Bijgewerkt 2026-07-04T19:27:01Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.