{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T07:00:32Z","timestamp":1790838032040,"version":"4.1.0"},"reference-count":41,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"unspecified","delay-in-days":42,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Beijing Municipal Natural Science Foundation","award":["7244353"],"award-info":[{"award-number":["7244353"]}]},{"name":"Beijing Natural Science Foundation\u2013Daxing Innovation Joint Fund","award":["Grant No. L246047"],"award-info":[{"award-number":["Grant No. L246047"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2026,7,24]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Circulating proprotein convertase subtilisin\/kexin 9 (PCSK9) levels may differ by sex and geographic region, but evidence remains inconsistent. This systematic review and meta-analysis quantifies these differences in adults with hyperlipidaemia, atherosclerotic cardiovascular disease (ASCVD) or elevated ASCVD risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We searched MEDLINE, Web of Science, Cochrane Central and EMBASE through August 2024 for studies reporting plasma PCSK9 in \u226510 adults. Two reviewers extracted data and assessed bias. Random-effects models pooled standardised mean differences (SMDs) or means; heterogeneity was evaluated by I\n                      <jats:sup>2<\/jats:sup>\n                      , with subgroup and sensitivity analyses exploring its sources.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      For gender, 13 studies (5\u202f706 participants) showed significantly higher PCSK9 in females than males (SMD \u22120.35, 95%\u2009CI \u22120.49 to \u22120.20; p=0.033; I\n                      <jats:sup>2<\/jats:sup>\n                      =54%). Single-sex studies corroborated this: female-only mean 350.66\u2009ng\/mL (95%\u2009CI 301.86 to 399.46)\u2009versus male-only 228.36\u2009ng\/mL (95% CI 176.33 to 280.39). For region, 63 studies (34\u202f802 participants) from Asia, Europe and North America yielded no significant overall difference (p=0.569); after outlier exclusion, pooled means were 250.39 (95% CI 217.70 to 283.08), 269.27 (95% CI 230.24 to 308.31) and 301.76 (95% CI 194.28 to 409.23)\u2009ng\/mL, with I\n                      <jats:sup>2<\/jats:sup>\n                      =0% within subgroups. Sensitivity analyses confirmed robustness; most studies were high quality. GRADE (Grading of Recommendations, Assessment, Development and Evaluation) certainty was moderate for sex and low for region.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In these clinical populations, women have higher circulating PCSK9 levels than men, while regional differences were not statistically significant. These findings support gender-conscious interpretation of baseline PCSK9 values but do not establish PCSK9 inhibitor dosing or treatment strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2024-002372","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T12:40:49Z","timestamp":1786538449000},"page":"e002372","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Gender and region disparities in plasma PCSK9 levels: a systematic review and meta-analysis"],"prefix":"10.1136","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5367-6811","authenticated-orcid":false,"given":"Tongyue","family":"Li","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China"},{"name":"China International Neuroscience Institute (China-INI), Beijing, China"},{"name":"First Clinical Medical College, Xuanwu Hospital, Capital Medical University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhengyu","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China"},{"name":"China International Neuroscience Institute (China-INI), Beijing, China"},{"name":"First Clinical Medical College, Xuanwu Hospital, Capital Medical University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haozhi","family":"Gong","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China"},{"name":"China International Neuroscience Institute (China-INI), Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China"},{"name":"China International Neuroscience Institute (China-INI), Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xue","family":"Wang","sequence":"additional","affiliation":[{"name":"Medical Library, Xuanwu Hospital, Capital Medical University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yifan","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China"},{"name":"China International Neuroscience Institute (China-INI), Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renjie","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China"},{"name":"China International Neuroscience Institute (China-INI), Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ran","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China"},{"name":"China International Neuroscience Institute (China-INI), Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bin","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China"},{"name":"China International Neuroscience Institute (China-INI), Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China"},{"name":"China International Neuroscience Institute (China-INI), Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jichang","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China"},{"name":"China International Neuroscience Institute (China-INI), Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4982-6295","authenticated-orcid":false,"given":"Liqun","family":"Jiao","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China"},{"name":"China International Neuroscience Institute (China-INI), Beijing, China"},{"name":"Department of Interventional Radiology, Xuanwu Hospital, Capital Medical University, Beijing, 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