Associazione Nazionale Medici Cardiologi Ospedalieri



A Clash of Cholesterol Titans: Statin-Intolerant vs. Statin-Tolerant Patients on PCSK9 Inhibitors in long term follow-up

Matteucci Andrea Roma(Roma) – SFN | Alonzo Alessandro Roma(ROMA) – SFN | Castello Lorenzo Roma(ROMA) – SFN

Introduction: Statin intolerance remains a clinical challenge in the management of dyslipidemia. This study aimed to investigate whether patients with statin intolerance, receiving PCSK9 inhibitors, exhibit lipid profile improvement different from those obtained in those without statin intolerance.

Methods: In this monocentric outpatient study we enrolled 381 dyslipidemic patients receiving PCSK9 inhibitors. Statin intolerance was defined according to ESC criteria. Patients were divided into two groups, clinical data were collected, and lipid profiles were monitored regularly for a total of 36 months.

Results: Among the statin-intolerant patients, there was a higher proportion of women compared to those on statin therapy (38.6% vs 27.2% p = 0.051), although among intolerants the majority were men (69% vs 31% p = 0.023). Statin-intolerant patients had higher baseline total cholesterol (242±29.8 mg/dL vs 221±26.3 mg/dL p < 0.001) and LDL cholesterol (161.4±39.7 mg/dL vs 147±37.1 mg/dL p = 0.010). Interestingly, lipid reduction in both groups became comparable as early as 6 months (LDL 67±37 mg/dL vs 63±39 mg/dL p = 0.42) and continued to be similar at 12 and 36 months of follow-up (LDL 74±44 mg/dL vs 69±29 mg/dL p = 0.62). Conclusion: PCSK9 inhibitors effectively lower lipid levels in both statin-intolerant and statin-tolerant dyslipidemic patients. Statin-intolerant patients seem to have similar management and can achieve cholesterol levels comparable to patients on statin therapy.