ABSTRACT NUMBER: ESOC2026YS267 NMR LIPOPROTEIN PARTICLE PROFILING IN CEREBROVASCULARDISEASE: DIFFERENTIAL EFFECTS OF STATINS, EZETIMIBE, AND PCSK9 INHIBITORS

Abstract Background and aims Traditional lipid testing may not fully capture cerebrovascular risk, as it focuses on cholesterol content rather than the number, size, and composition of lipoprotein particles, key features of a modifiable pathway in cerebrovascular disease. Nuclear magnetic resonance (NMR) spectroscopy provides detailed lipoprotein profiling. However, the effects of lipid-lowering therapies on these particle measures remain incompletely understood. Methods We are conducting a prospective cohort study evaluating the effects of statins, ezetimibe, and PCSK9 inhibitors on lipoprotein particle concentration and size using fasting NMR lipid profiling. Adults with clinical and radiological cerebrovascular disease and/or white matter disease will be enrolled from neurovascular clinics and inpatient admissions. Both lipid-lowering–naïve and previously treated patients will be included; in treated patients, baseline sampling will precede starting a new agent and/or treatment intensification per the treating physician. Therapy may be monotherapy or combination, guided by clinical and NMR findings and attending practice. NMR profiles will be obtained at baseline and repeated at 6 months. If therapy is modified before 6 months, NMR will be repeated at the time of change and follow-up will continue. Clinical, laboratory, and radiological data will be collected longitudinally as standard of care. Adherence will be assessed by patient report and pharmacy refill records. Analyses will use adjusted models to account for baseline differences between treatment groups. Results The study was initiated one month ago. Recruitment procedures have been implemented in the stroke clinics and the neurovascular unit, and patient enrollment and data collection are currently ongoing. Conflict of interest Adi A. Aldubaiyan: nothing to disclose, Muna S. Alnamlah: nothing to disclose, Mohammed Alqurishi: nothing to disclose, Mohammed Alkhudair: nothing to disclose, Haifa Alsuwaine: nothing to disclose, Ashfaq Shuaib: nothing to disclose, Naser Alotaibi: nothing to disclose