{"id":"755af6315e74","type":"article","url":"https://hartvaat.nl/2026/11/01/pcsk9-remmers-verlagen-lipoproteine-a-met-1519-in-real-world-cohort/","title":"PCSK9-remmers verlagen Lipoproteïne(a) met 15–19% in real-world cohort","title_en":"Lipoprotein(a) reduction with PCSK9-targeting pharmacotherapy: A prospective real-world registry study.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":[],"journal":"Atherosclerosis","doi":"10.1016/j.atherosclerosis.2026.121912","source_url":"https://doi.org/10.1016/j.atherosclerosis.2026.121912","authors":["Jan Kafol","Zlatko Fras","Marko Novakovic","Matija Cevc","Barbara Krevel","Lenart Kafol","Anamarija Kelenc","Klarisa Kepic","Katarina Vrbinc","Miha Svarc","Urh Groselj","Borut Jug"],"significance":5,"published":"2026-11-06","source_date":"2026-11-01","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/pcsk9-remmers-evolocumab-alirocumab/","https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"A prospective single-centre registry of 1,112 patients evaluated the real-world efficacy of PCSK9 inhibitors (alirocumab, evolocumab, inclisiran) on Lipoprotein(a) levels. Over 21 months, therapy yielded a sustained mean reduction of 19%, with no statistically significant differences between agents after propensity weighting. These findings confirm that PCSK9 inhibitors provide a modest but durable Lp(a) lowering effect in routine practice, albeit smaller than observed in randomised trials, underscoring the ongoing need for targeted Lp(a)-specific therapies.","created":"2026-10-30T02:26:58Z","updated":"2026-10-30T02:26:58Z","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":"In een prospectieve single-centre cohortstudie van 1112 patiënten onderzochten onderzoekers de effectiviteit van PCSK9-remmers (alirocumab, evolocumab, inclisiran) op Lipoproteïne(a). Na 21 maanden werd een gemiddelde daling van 19,0% waargenomen, zonder significant verschil tussen de verschillende middelen. Deze real-world gegevens bevestigen dat PCSK9-remmers een bescheiden maar duurzame Lp(a)-daling geven, zij het minder sterk dan in gerandomiseerde trials, wat de noodzaak van gerichte nieuwe therapieën onderstreept.","abstract_original":"BACKGROUND AND AIMS: Lipoprotein(a) is an independent cardiovascular risk factor with limited therapeutic options. Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) reduce lipoprotein(a), but comparative real-world data across available agents are scarce. We aimed to evaluate lipoprotein(a) reduction with PCSK9i in a large prospective registry. METHODS: We analysed 1112 patients from a prospective single-centre PCSK9i registry with available baseline lipoprotein(a) measurements and follow-up data. Patients received alirocumab, evolocumab, or inclisiran according to clinical practice. Lipoprotein(a) changes were assessed at 3, 9, and 21 months using mixed-effects models and inverse probability of treatment weighting (IPTW). RESULTS: Clinical atherosclerotic disease was present in 52.4% of patients; median baseline LDL-C and lipoprotein(a) concentrations were 3.8 mmol/L (IQR 2.4-4.9) and 67.3 mg/dL (IQR 13.9-130.8), respectively. PCSK9i therapy resulted in a significant and sustained reduction in lipoprotein(a), with mean changes of -15.3%, -16.7%, and -19.0% at 3, 9, and 21 months, respectively (all p < 0.001). In unadjusted analyses, reductions ranged from -14% to -21% with alirocumab and evolocumab and from -8% to -17% with inclisiran. After IPTW adjustment, similar patterns were observed (-13% to -19% vs -8% to -17%), with no statistically significant differences between treatment groups at any time point (all p > 0.05). CONCLUSIONS: In this large real-world cohort, PCSK9i therapies produced modest but significant reductions in lipoprotein(a). No statistically significant differences between agents were detected, although estimates for inclisiran were less precise because of the smaller sample size. Reductions were smaller than in randomised clinical trials, highlighting the need for targeted therapies."}