{"id":"ebc71946dcdf","type":"article","url":"https://hartvaat.nl/2026/04/25/preoperatieve-pcsk9-remming-associeert-met-minder-postoperatieve-mace-dan-statin/","title":"Preoperatieve PCSK9-remming associeert met minder postoperatieve MACE dan statines","title_en":"","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":["enlicitide","niet-statine-therapie","pcsk9-remmers","pcsk9-remmers-nieuwe-generatie"],"journal":"Atherosclerosis","doi":"10.1016/j.atherosclerosis.2026.120760","source_url":"https://doi.org/10.1016/j.atherosclerosis.2026.120760","authors":["Hsiang-Ling Wu","Jui-Tai Chen","Juan Pablo Cata","Yih-Giun Cherng","Ying-Hsuan Tai"],"significance":6,"published":"2026-05-04","source_date":"2026-04-25","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/pcsk9-mechanisme/","https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"An active-comparator cohort study (TriNetX, 35,923 propensity-matched pairs) compared perioperative PCSK9 inhibitors with statins in hyperlipidaemia patients undergoing surgery between July 2015 and June 2025. PCSK9 inhibitors were associated with lower 30-day MACE (6.4% vs 9.6%; NNT 31; RR 0.67), all-cause mortality (RR 0.45), acute kidney injury (RR 0.45) and respiratory infections (RR 0.77), as well as less delirium (RR 0.41) and transaminase rise. RCTs are needed to rule out residual confounding.","created":"2026-07-03T10:32:51Z","updated":"2026-07-03T13:31:46Z","licence":"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.","body_markdown":"Active-comparator cohortstudie (TriNetX, 35.923 propensity-gematchte paren) vergeleek perioperatieve PCSK9-remming met statinegebruik bij hyperlipidemiepatiënten die een operatie ondergingen tussen juli 2015 en juni 2025. PCSK9-remmers waren geassocieerd met lagere 30-daagse MACE (6,4% vs 9,6%; NNT 31; RR 0,67), all-cause sterfte (RR 0,45), acute nierschade (RR 0,45) en respiratoire infecties (RR 0,77). Ook delier (RR 0,41) en transaminasestijging kwamen minder vaak voor. RCT's zijn nodig om residual confounding uit te sluiten.","abstract_original":"BACKGROUND AND AIMS: Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors achieve substantial reductions in low-density lipoprotein cholesterol, yet their effectiveness and safety in the perioperative setting have not been fully delineated. The present study evaluated postoperative adverse events among patients treated with preoperative PCSK9 inhibitors versus statins. METHODS: We conducted a 1:1 propensity score-matched, active-comparator cohort study using the TriNetX research database, including adults with hyperlipidemia who underwent surgery at U.S. medical institutions between July 1, 2015, and June 30, 2025, and who received either PCSK9 inhibitors or statins within 90 days before surgery. The primary outcome was 30-day postoperative major adverse cardiovascular events (MACEs). Secondary outcomes included all-cause mortality, acute kidney injury (AKI), respiratory infections, and other complications. RESULTS: Among the 35,923 matched pairs, PCSK9 inhibitor use was associated with significantly lower risks of 30-day MACEs [6.4% vs. 9.6%; number needed to treat: 31; relative risk (RR): 0.67, 95% confidence interval (CI): 0.63-0.70], all-cause mortality (RR: 0.45: 95% CI: 0.35-0.58), AKI (RR: 0.45: 95% CI: 0.41-0.49), and respiratory infections (RR: 0.77: 95% CI: 0.71-0.83; all p < 0.0001). These associations remained consistent across postoperative time intervals and therapy duration strata. Furthermore, PCSK9 inhibitor use was associated with reduced risks of delirium (RR: 0.41: 95% CI: 0.28-0.60) and elevated liver enzymes (RR: 0.58: 95% CI: 0.48-0.70). CONCLUSIONS: Preoperative PCSK9 inhibitor therapy was associated with more favorable perioperative outcomes and a better safety profile compared with statins. Randomized controlled trials are warranted to confirm these results."}