Impact of conventional lipid-lowering therapy on circulating levels of proprotein convertase subtilisin/kexin type 9: A systematic review and meta-analysis of randomised controlled trials
Abstract
Conventional lipid-lowering agents, such as statins, ezetimibe, fibrates, bile acid sequestrants, nicotinic acid, bempedoic acid, and omega-3, play a pivotal role in managing dyslipidemia. Despite their benefits, these agents are associated with increased levels of plasma proprotein convertase subtilisin kexin 9 (PCSK9), a serine protease linked to elevated cardiovascular risk. The literature lacks comprehensive data on how these commonly used drugs collectively impact circulating PCSK9 levels alongside their lipid-modifying effects. This review addresses this gap by systematically analysing the effects of these agents on PCSK9 and lipid profiles. Following the preferred reporting items for systematic review and meta-analysis protocols guidelines, this study conducts a systematic search across multiple databases including MEDLINE, Cochrane Central, EMBASE, Web of Science, SCOPUS, and ScienceDirect. We include published, peer-reviewed randomised controlled trials (RCTs) that involve adult patients undergoing monotherapy or combination therapy with the mentioned lipid-lowering drugs for at least 2 weeks, with recorded PCSK9 levels at baseline and post-treatment. Our analysis encompasses data extraction and bias assessment independently performed by two researchers, utilising standardised mean difference for continuous data and risk ratios for dichotomous data. We also conduct subgroup and sensitivity analyses to assess treatment intensity, drug types, comorbidities, and…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 1,313 participants or records.
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