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

Background PCSK9 inhibitors (PCSK9i) significantly lower LDL cholesterol and improve cardiovascular outcomes but 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/rural residence, and specialist involvement. Results Among 15,286 eligible individuals, only 150 (0.98%) were prescribed PCSK9i. In multivariable analysis, those receiving PCSK9i were less likely to be female (Adjusted OR 0.50 (0.30, 0.81), p=0.005), had higher baseline LDL-c levels (adjusted OR 1.47 (1.23, 1.74), p < 0.001), had higher rates of ASCVD (adjusted OR 5.58 (1.63, 14.50), p=0.003) and were more likely to have seen a specialist physician (adjusted OR 6.64 (2.69, 21.50), p < 0.001). They were also more likely to reside in a higher income neighbourhood. Conclusions PCSK9i 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.