Lower body mass index is associated with the achievement of target LDL in patients using PCSK9 inhibitors in Taiwan.

Objective: Proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors are a standard therapy for patients who respond poorly to or cannot tolerate statins. However, identifying responders to PCSK9 inhibitors remains unclear. This study investigates the characteristics of patients who achieve target LDL-C reduction (< 70 mg/dl) after PCSK9 inhibitor therapy.

Methods: A multicenter, retrospective cohort study included patients initiating PCSK9 inhibitors at 11 teaching hospitals in Taiwan (2017-2021). Baseline characteristics, lipid-lowering therapies, and lipid profile changes were analyzed.

Results: Among 211 patients (mean age 57.2 ± 13.1 years, 72.0% male), 73.5% used alirocumab and 26.5% used evolocumab. More than half had coronary artery disease and/or hypertension. Of these, 120 patients achieved the LDL-C target. Target achievers had a lower baseline BMI (25.8 ± 3.7 vs. 27.4 ± 4.5 kg/m², P = 0.028) and a higher incidence of myocardial infarction and anti-platelet use compared to non-achievers. Baseline cholesterol and LDL-C levels were similar, but target achievers experienced greater LDL-C reductions (- 71.5; IQR - 81.8, - 62.2 vs. - 29.4; IQR - 38, - 10.5 mg/dl, P < 0.001), as well as decreases in triglycerides and increases in HDL-C. Glucose levels and liver enzymes did not differ significantly. Logistic regression revealed BMI as the only independent predictor of LDL-C target achievement (odds ratio: 0.899, 95% CI 0.821-0.984, P = 0.021).

Conclusions: Lower BMI at baseline was associated with a higher likelihood of achieving LDL-C < 70 mg/dl after 12 weeks of PCSK9 inhibitor therapy. These findings support personalized strategies for optimizing cholesterol management in statin-intolerant patients while further investigations are required.