Abstract Body (Do not enter title and authors here): Background: PCSK9 inhibitors significantly reduce LDL-C levels and cardiovascular events in patients with atherosclerotic cardiovascular disease (ASCVD), particularly following acute coronary syndromes (ACS) and in those with familial hypercholesterolemia (FH). However, equitable inpatient access to these therapies remains unclear.

Objective: To assess racial and socioeconomic disparities in inpatient utilization of PCSK9 inhibitors among patients hospitalized with ASCVD, with a focus on post-ACS and FH subgroups.

Methods: We conducted a retrospective cross-sectional study using the National Inpatient Sample (NIS) from 2020 to 2022. Adult hospitalizations with a diagnosis of ASCVD, including ACS and FH, were identified using ICD-10 codes. Inpatient PCSK9 inhibitor use was determined by pharmacy billing codes. Patients were stratified by race/ethnicity and income quartile. Multivariable logistic regression was used to calculate adjusted odds ratios (aOR) for PCSK9i utilization, controlling for demographics, insurance, comorbidities, and hospital-level factors.

Results: Among 180,000 weighted ASCVD hospitalizations, only 1.3% received PCSK9 inhibitors. Black (aOR 0.58, 95% CI 0.50–0.68) and Hispanic (aOR 0.61, 95% CI 0.52–0.72) patients were significantly less likely than White patients to receive PCSK9is. Patients in the lowest income quartile had 47% lower odds of treatment compared to the highest (aOR 0.53, 95% CI 0.45–0.63). In post-ACS patients, PCSK9i use was 2.1% for White vs. 0.9% for Black patients. Similar trends were observed in FH patients.

Conclusion: Inpatient use of PCSK9 inhibitors remains extremely limited and disproportionately lower among Black, Hispanic, and low-income patients with ASCVD. These findings highlight critical disparities in access to high-efficacy lipid-lowering therapy and underscore the need for equitable inpatient prescribing practices.