Evidence map›PCSK9 inhibitors × all-cause mortality›PMID 35706032›Full record

ArticleCardiovascular diabetology2022

PCSK9 inhibitors for secondary prevention in patients with cardiovascular diseases: a bayesian network meta-analysis.

Xing Wang, Dingke Wen, Yuqi Chen, Lu Ma, Chao You

Open access · goldFull text readNetwork Meta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Article in Cardiovascular diabetology, 2022. The graph read 3 numbers from its abstract, feeding 2 cells of the map: it supports the treatment in 1. It also reports an association that does not count as treatment evidence, such as RR 0.94 (0.90 to 0.99) for adverse events & safety. Cited by 40 papers, 7 of them syntheses that pooled it.

3numbers the graph read from it
1cell of the map it votes in
40citing papers in PubMed, 7 pooled it
13.5field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

← favours the treatmentfavours the comparator →
1 · no effect
All-cause mortalityfavours the treatment · against placebo · ascvdfeeds one cell of the map
RR 0.830.72 to 0.95
The use of alirocumab was associated with reductions in all-cause mortality compared with control (RR 0.83, 95% CrI 0.72-0.95).
FeedsPCSK9 inhibitors×all-cause mortality

Read, but not usablea number the graph found but could not read as for or against

Adverse events & safetyan association or prognostic statement, not a treatment comparison · ascvdfeeds one cell of the map
RR 0.940.90 to 0.99
We also found alirocumab was associated with decreased risk of serious adverse events (RR 0.94, 95% CrI 0.90-0.99).
FeedsPCSK9 inhibitors×adverse events & safety
All-cause mortalitycomparator not stated · ascvdfeeds one cell of the map
RR 1.261.04 to 1.52
Moreover, evolocumab was associated with increased all-cause mortality compared with alirocumab (RR 1.26, 95% CrI 1.04-1.52).
FeedsPCSK9 inhibitors×all-cause mortality

clause the extractor read what became the number

2 · Its place on the map

Where it lands on the map

Rows are treatments, columns are outcomes. The coloured squares are the cells this paper feeds, coloured by the vote it casts there. Click one to jump to what this paper adds to it.

supports the treatmentfavours the comparatorno clear differenceread, but no usable result
3 · What it changes

What it adds to each cell

For every cell the paper feeds: the belief in the claim with and without this paper, and this paper's estimate drawn against every other readable study in the cell. The ringed dot is this paper.

PCSK9 inhibitors×all-cause mortality

SupportsOpen on the map →What to test next →

3 readable studies in this cell: 3 favour the treatment, 0 find no difference, 0 favour the comparator.

Belief with this paper
1.00replicated · 2 families support, 0 contradict · against placebo
Without itNot a counted family in this claim, so removing it changes nothing.
← favours the treatmentfavours the comparator →
1 · no effect
NCT0176463327,564 enrolled · 2013
HR 0.850.79 to 0.92
NCT0166340218,924 enrolled · 2012
HR 0.860.79 to 0.93
NCT0387240112,301 enrolled · 2019
HR 0.750.65 to 0.86

This paper's own estimate is on a different scale from the rest of the cell, so it is not drawn here.

PCSK9 inhibitors×adverse events & safety

No readable resultOpen on the map →What to test next →

5 readable studies in this cell: 3 favour the treatment, 2 find no difference, 0 favour the comparator.

Belief with this paper
0.00contested · 0 families support, 4 contradict · against placebo
Without itNot a counted family in this claim, so removing it changes nothing.
← favours the treatmentfavours the comparator →
1 · no effect
NCT0176463327,564 enrolled · 2013
HR 0.850.79 to 0.92
NCT0166340218,924 enrolled · 2012
HR 0.850.78 to 0.93
NCT04873934400 enrolled · 2021
OR 0.760.43 to 1.35

This paper's own estimate is on a different scale from the rest of the cell, so it is not drawn here.

4 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

5 · Its place in the literature

Who cites it

40 citing papers in PubMed, 7 syntheses or guidelines pooled it, 65 citations in OpenAlex.

  1. Efficacy of PCSK9 Inhibitors on Clinical Outcomes in Patients with Established Atherosclerotic Cardiovascular Disease: A Network Meta-analysis.American journal of cardiovascular drugs : drugs, devices, and other interventions · 2026 · on this map
    Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Pooled it
  6. Pooled it
  7. Pooled it
  8. Article
  9. Article
  10. Article
  11. Review
  12. Therapeutic Management of LDL-C: Efficacy and Economic Impact Assessment.Journal of cardiovascular development and disease · 2025
    Review
  13. Article
  14. Review
  15. Article
  16. Review
  17. Article
  18. Article
  19. Review
  20. Review
6 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

7 · Who and what money

Authors and funding

5 authors at 2 institutions in 1 country.

Xing WangWest China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China.
Dingke WenWest China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China.
Yuqi ChenWest China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China.
Lu MaWest China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China. alex80350305@163.com.
Chao YouWest China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China. dr.chaoyou@outlook.com.
Sichuan University · CNWest China Hospital of Sichuan University · CN

Funding

No grant is acknowledged in the PubMed record.

8 · The paper itself

Abstract

The marked sentences are the ones the graph read a number from.

backgroundThe Food and Drug Administration has approved Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) inhibitors for the treatment of dyslipidemia. However, evidence of the optimal PCSK9 agents targeting PCSK9 for secondary prevention in patients with high-risk of cardiovascular events is lacking. Therefore, this study was conducted to evaluate the benefit and safety of different types of PCSK9 inhibitors.

methodsSeveral databases including Cochrane Central, Ovid Medline, and Ovid Embase were searched from inception until March 30, 2022 without language restriction. Randomized controlled trials (RCTs) comparing administration of PCSK9 inhibitors with placebo or ezetimibe for secondary prevention of cardiovascular events in patients with statin-background therapy were identified. The primary efficacy outcome was all-cause mortality. The primary safety outcome was serious adverse events.

resultsOverall, nine trials totaling 54,311 patients were identified. Three types of PCSK9 inhibitors were evaluated. The use of alirocumab was associated with reductions in all-cause mortality compared with control (RR 0.83, 95% CrI 0.72-0.95). Moreover, evolocumab was associated with increased all-cause mortality compared with alirocumab (RR 1.26, 95% CrI 1.04-1.52). We also found alirocumab was associated with decreased risk of serious adverse events (RR 0.94, 95% CrI 0.90-0.99).

conclusionsIn consideration of the fact that both PCSK9 monoclonal antibody and inclisiran enable patients to achieve recommended LDL-C target, the findings in this meta-analysis suggest that alirocumab might provide the optimal benefits regarding all-cause mortality with relatively lower SAE risks, and evolocumab might provide the optimal benefits regarding myocardial infarction for secondary prevention in patients with high-risk of cardiovascular events. Further head-to-head trials with longer follow-up and high methodologic quality are warranted to help inform subsequent guidelines for the management of these patients.

Indexed as

Anticholesteremic AgentsCardiovascular DiseasesHumansPCSK9 InhibitorsProprotein Convertase 9Secondary PreventionAnticholesteremic AgentsPCSK9 InhibitorsPCSK9 protein, humanProprotein Convertase 9AtherosclerosisCardiovascular diseasePCSK9 inhibitorsSecondary prevention

Identifiers

PMID35706032
PMCPMC9202167
OpenAlexW4282930542

What Socratic holds

Textfull text, public
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.