{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T06:27:02Z","timestamp":1787725622936,"version":"build-2784847793"},"reference-count":25,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:00:00Z","timestamp":1787616000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:00:00Z","timestamp":1787616000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["aocs.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Lipids"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Lipid management after heart transplantation (HT) is complicated by post\u2010transplant dyslipidemia, immunosuppression, statin intolerance, and cardiac allograft vasculopathy (CAV). Proprotein convertase subtilisin\/kexin Type 9 (PCSK9) inhibitors lower LDL\u2010C in non\u2010transplant populations, but HT recipients were under\u2010represented in pivotal lipid trials. This updated systematic review and exploratory meta\u2010analysis synthesized full\u2010text evidence of PCSK9 inhibition after adult HT, predominantly with alirocumab or evolocumab. LDL\u2010C lowering was the primary lipid outcome. CAV imaging\/physiology, rejection, donor\u2010specific antibodies, immunosuppression stability, and safety were secondary outcomes. PubMed\/MEDLINE, Scopus, Cochrane Library, and Google Scholar were searched through June 20, 2026. Sixteen primary studies were included. Two independent randomized trials, EVOLVD and CAVIAR, both conducted during the first post\u2010transplant year, provide the highest\u2010quality evidence. The remaining evidence consists of an EVOLVD physiology\/OCT substudy and observational or case\u2010based reports. Ten studies contributed LDL\u2010C effect and variance data. The exploratory random\u2010effects summary estimated an LDL\u2010C reduction of 73.6\u2009mg\/dL (95% CI, 58.8\u201388.4,\n                    <jats:italic>I<\/jats:italic>\n                    <jats:sup>2<\/jats:sup>\n                    \u2009=\u200989.8%). The randomized\u2010trial subgroup showed a smaller but consistent reduction of 41.8\u2009mg\/dL (95% CI, 35.9\u201347.7). Observational estimates were larger but derived from selected, lower\u2010certainty cohorts. Randomized first\u2010year evidence did not show clear improvement in CAV imaging or coronary physiology. PCSK9 inhibition lowers LDL\u2010C after HT and appears tolerable, but CAV modification and graft\u2010outcome benefit remain unproven.\n                  <\/jats:p>","DOI":"10.1002\/lipd.70082","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T05:46:56Z","timestamp":1787723216000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["<scp>PCSK9<\/scp>\n                    Inhibition Lowers\n                    <scp>LDL<\/scp>\n                    Cholesterol After Heart Transplantation: An Updated Systematic Review and Meta\u2010Analysis"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1926-3535","authenticated-orcid":false,"given":"Hamzah Pratama","family":"Megantara","sequence":"first","affiliation":[{"name":"Faculty of Medicine Universitas Indonesia  Jakarta Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4668-3916","authenticated-orcid":false,"given":"Naura","family":"Anjanie","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Universitas Airlangga  Surabaya Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-8851-1877","authenticated-orcid":false,"given":"Joeristanti","family":"Soelistyaningroem","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Mitra Keluarga Cibubur General Hospital  Bekasi Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,25]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598\u2010025\u201022916\u20100"},{"key":"e_1_2_12_3_1","first-page":"1","article-title":"The Potential Role of PCSK9 Inhibitors in Heart Transplant Patients: A Case Series","volume":"18","author":"Al Tamimi A.","year":"2025","journal-title":"Journal of Cardiology and Current Research"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2024.04.026"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11897\u2010023\u201000603\u20101"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2016.04.033"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2010.05.034"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000002520"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacl.2021.05.003"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.125.077603"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rec.2019.08.002"},{"key":"e_1_2_12_12_1","unstructured":"International Committee of Medical Journal Editors.2026.\u201cRecommendations for the Conduct Reporting Editing and Publication of Scholarly Work in Medical Journals.\u201dhttps:\/\/www.icmje.org\/recommendations\/."},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000002944"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10741\u2010022\u201010255\u20105"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2025.07.037"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0210373"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2018.11.004"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cardfail.2021.02.018"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacl.2019.06.010"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i4919"},{"key":"e_1_2_12_22_1","volume-title":"RoB 2: A Revised Tool for Assessing Risk of Bias in Randomised Trials","author":"Sterne J. 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