Sociodemographic Characteristics Associated with PCSK9 Inhibitor Use in Individuals with Possible Familial Hypercholesterolemia in Alberta: A Cohort Study

IF 2.1 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open Pub Date : 2026-07-01 Epub Date: 2026-03-12 DOI:10.1016/j.cjco.2026.03.002

Samuel E. Fineblit MD, FRCPC, David M. Vickers PhD, David J.T. Campbell MD, MSc, PhD, FRCPC

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Abstract

Background

Proprotein convertase subtilisin/kinase type 9 inhibitors (PCSK9is) significantly lower low-density lipoprotein cholesterol (LDL-c) level and improve cardiovascular outcomes, but they remain underutilized, potentially due to access-related barriers. This study examines clinical and sociodemographic factors associated with PCSK9i prescriptions in Alberta, Canada.

Methods

A population-based study was conducted using data from the Alberta Kidney Disease Network. Adults with possible familial hypercholesterolemia (LDL-c ≥ 5 mmol/L) and suboptimal LDL-c control despite high-intensity statin therapy were included. Individuals with ≥ 3 dispensations of PCSK9i formed the treatment cohort. Multivariable logistic regression analysis was performed based on the identified variables, including neighbourhood income, material and social deprivation, sex, age, urban vs rural residence, and specialist involvement.

Results

Among 15,286 eligible individuals, only 150 (0.98%) were prescribed PCSK9is. In multivariable analysis, those receiving PCSK9is were less likely to be female (adjusted odds ratio (OR) 0.50, 95% confidence interval (CI) [0.30, 0.81], P = 0.005), had higher baseline LDL-c levels (adjusted OR 1.47, CI [1.23, 1.74], P < 0.001), had higher rates of atherosclerotic cardiovascular disease (adjusted OR 5.58, CI [1.63, 14.50], P = 0.003), and were more likely to have seen a specialist physician (adjusted OR 6.64, CI [2.69, 21.50], P < 0.001). They were also more likely to reside in a higher-income neighbourhood.

Conclusions

PCSK9is are markedly under-prescribed in patients with severe hypercholesterolemia in Alberta. Prescription patterns have distinct differences by sex, specialist access, and neighbourhood income. Policy changes to improve equitable access, especially for disadvantaged populations, may help to reduce cardiovascular risk and improve outcomes.

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艾伯塔省可能的家族性高胆固醇血症患者使用PCSK9抑制剂相关的社会人口学特征：一项队列研究

蛋白转化酶枯草杆菌素/激酶9型抑制剂（PCSK9is）可显著降低低密度脂蛋白胆固醇（LDL-c）水平并改善心血管结局，但它们仍未得到充分利用，可能是由于准入相关的障碍。本研究考察了加拿大阿尔伯塔省与PCSK9i处方相关的临床和社会人口因素。方法利用阿尔伯塔肾脏疾病网络的数据进行了一项基于人群的研究。包括可能患有家族性高胆固醇血症（LDL-c≥5 mmol/L）的成年人，尽管高强度他汀类药物治疗，但LDL-c控制不佳。PCSK9i配剂≥3个的个体组成治疗队列。根据确定的变量，包括邻里收入、物质和社会剥夺、性别、年龄、城市与农村居住以及专家参与，进行多变量logistic回归分析。结果15286名符合条件的个体中，仅150人（0.98%）开具了pcsk9处方。在多变量分析中，接受pcsk9的患者女性较少（校正优势比（OR） 0.50, 95%可信区间（CI） [0.30, 0.81], P = 0.005），基线LDL-c水平较高（校正优势比（OR） 1.47, CI [1.23, 1.74], P = 0.001），动脉粥样硬化性心血管疾病发生率较高（校正优势比（OR） 5.58, CI [1.63, 14.50], P = 0.003），并且更有可能就诊专科医生（校正优势比（OR） 6.64, CI [2.69, 21.50], P < 0.001）。他们也更有可能居住在高收入社区。结论在艾伯塔省严重高胆固醇血症患者中，spcsk9is的处方明显不足。处方模式在性别、专科就诊和邻里收入方面存在明显差异。改变政策以改善公平获取，特别是对弱势群体而言，可能有助于降低心血管风险和改善结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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