PCSK9 inhibitors × cardiovascular events

SynthesisBMC cardiovascular disorders2025

Efficacy and safety of PCSK-9 inhibitors in patients with acute coronary syndrome: a systematic review and network meta-analysis.

Guoying Kao et al.PubMed ↗Full text ↗Publisher ↗

  • PCSK9 inhibitorslooks good hereLower LDL cholesterol, lower major heart events.Randomised, large.
  • Alirocumabno clear effectNo clear effect on major heart events.Nothing cleared the noise.

What the trial testedrandomised · 37,934 people · 2025

Randomised vs control (placebo or standard care)

Lowered LDL cholesterol

−52.7mg/dL−61.2 to −44.1

PCSK9 inhibitors vs control (placebo or standard care)

As reported

difference −52.7 mg/dL, 95% CI −61.2 to −44.1 · the paper's word: LDL-C

Randomised vs control (placebo or standard care)

Lowered major heart events

−21%−32% to −7%

PCSK9 inhibitors vs control (placebo or standard care)

Bigger than 5 in 10 for cardiovascular events

As reported

OR 0.79, 95% CI 0.68–0.93 · the paper's word: MACE

Range includes no effect

No clear effect on major heart events

−16%−32% to +3%

Alirocumab vs Evolocumab

Bigger than 3 in 10 for cardiovascular events

As reported

OR 0.84, 95% CI 0.68–1.03 · the paper's word: MACE

Who was studied, and how

37,934people with cardiovascular disease, in this paper

The trial randomly assignedassigned by chance

Alirocumab
Evolocumab

No clear effect on major heart events−16%

randomised

The trial randomly assignedassigned by chance

PCSK9 inhibitors
control (placebo or standard care)

Lowered LDL cholesterol−52.7

Lowered major heart events−21%

randomised

the abstract, start to end

not statistically significant (OR: 0.84; 95% CI: 0.68-1.03).

reduced LDL-C (mean difference [MD]: - 52.7 mg/dL; 95% CI: - 61.2 to - 44.1) and lowered the risk of MACE (odds ratio [OR]: 0.79; 95% CI: 0.68-0.93).

← favours treatmentfavours comparator →
could be chance
MACEAlirocumab vs Evolocumab
OR 0.840.68–1.03
LDL-CPCSK9 inhibitors vs control (placebo or standard care)
−52.7−61.2 to −44.1
MACEPCSK9 inhibitors vs control (placebo or standard care)
OR 0.790.68–0.93
PCSK9 inhibitorsLipidsCardiovascular events

PCSK9 inhibitors × cardiovascular eventshelps?settled

unlikelylikely
1.00not counted

PCSK9 inhibitors × lipidshelps?settled

unlikelylikely
0.93not counted
← favours treatmentfavours comparator →
more certainless certain
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3 papers cite it

2025
2026
this papertrialcites it
Full record →Abstract, authors, funding and every citing paper · PMID 40849610