The Use of PCSK9 Inhibitor Is Associated With More Adaptative Eating Behaviors Among Adults With Heterozygous Familial Hypercholesterolemia

Objectives: Heterozygous familial hypercholesterolemia (HeFH) is the most common genetic disorder linked to premature cardiovascular diseases (CVDs) worldwide.In HeFH, CVD prevention relies on LDL-cholesterol (LDL-C)-lowering medication use, in addition to healthy lifestyle habits, with diet being a cornerstone.The use of proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i), the most effective LDL-C-lowering drugs, could alleviate the perceived burden of the diet-to-LDL-C association and influence one's relationship with food.We aimed to compare eating behaviors (EBs) according to PCSK9i use in adults with HeFH.We hypothesized that PCSK9i users have more favorable EBs compared to nonusers, translating into more optimal diet quality and LDL-C levels.Methods: This cross-sectional study was conducted among 163 adults with HeFH, all using LDL-C-lowering medication.Intuitive eating (IE; an adaptive eating approach) was assessed using the IE Scale-2; disinhibition (a loss of control in eating) was assessed using the Three-Factor Eating Questionnaire.Diet quality was assessed using the Healthy Eating Food Index (HEFI)-2019, calculated using data from a food frequency questionnaire.Plasma LDL-C levels were measured using standard assays.Results: In multivariable-adjusted analyses, compared to PCSK9i nonusers (n116), users (n47) had a higher IE score (users: 3.73 [95% CI: 3.61, 3.86]; nonusers: 3.57 [3.49, 3.66]; P0.04) and lower disinhibition (users: 3.71 [3.03, 4.39]; nonusers: 4.39 [3.95, 4.83]; P0.04).No evidence of difference in the HEFI-2019 was observed between the two groups.While IE was positively associated with HEFI-2019 in both groups, it was inversely associated with LDL-C levels only among PKCS9i users, independent of diet quality ( LDL-C [95% CI] mmol/L per each IE point, users: -1.43 [-2.17, -0.70]; nonusers: -0.22 [-0.67, 0.23]; P interaction0.02).Conclusions: In adults with HeFH, PCSK9i users exhibited more adaptative EBs compared to nonusers.Despite being positively associated with diet quality, independent of PCSK9i use, these EBs were associated with lower LDL-C levels only among users.This suggests that EBs could play a key role in CVD prevention in HeFH.