Greater use of non-statin lipid-lowering therapies alongside intensified statin treatment was associated with lower low-density lipoprotein cholesterol (LDL-C) levels in heart-transplant (HT) recipients, according to a real-world observational study.

The single-center retrospective cohort study published in the High Blood Pressure and Cardiovascular Prevention included 238 adult HT recipients followed between August 2024 and March 2025. Lipid profiles, statin prescriptions, and non-statin LLT use were assessed and compared with corresponding data collected in 2019/2020. The study population had a median age of 64 years (interquartile range [IQR] 53.3–72.0 years), and 27% were women.

Median LDL-C levels significantly declined during follow-up among patients with paired lipid measurements, decreasing from 109.6 mg/dL (IQR 88.9–133.0) to 93.8 mg/dL (IQR 72.5–112.0; p<0.001).

Use of ezetimibe increased substantially over time, prescribed in 73 patients (30.7%) compared with 27 patients (11.3%) during the earlier assessment period (p<0.001). Additional non-statin therapies introduced during follow-up included proprotein convertase subtilisin/kexin type 9 inhibitor monoclonal antibodies (PCSK9i) in 10 patients (4.2%), inclisiran in 3 patients (1.3%), and bempedoic acid in 3 patients (1.3%). These therapies were not commercially available during the prior evaluation period.

The proportion of patients receiving statins also increased from 52.1% to 60.9% (p<0.001), primarily driven by greater adoption of high-intensity statin therapy.

Broader implementation of ezetimibe, PCSK9-targeting therapies, bempedoic acid, and intensified statin treatment was associated with improved LDL-C control in HT recipients in routine clinical practice.