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Background and Importance PCSK9 inhibitors (alirocumab and evolocumab) effectively reduce Low-density lipoprotein (LDLc) and cardiovascular risk, although evidence on their long-term real-world use remains limited.Aim and Objectives The aim is to compare LDLc reduction with alirocumab and evolocumab at 6 months, 5 years, and 8 years, analyse the proportion of patients achieving LDLc <55 mg/dL and <70 mg/dL and describe the incidence of cardiovascular events during follow-up.Material and Methods Retrospective observational study conducted in a tertiary hospital, including patients who started alirocumab 150 mg every 14 days, 300 mg monthly, or evolocumab 240 mg every 14 days, between 2016 and 2017. Demographic variables, follow-up duration, baseline LDLc, at 6 months, 5 years, and 8 years, as well as subsequent cardiovascular events, were recorded.The primary objective was to study LDLc levels from baseline to 6 months, 5 years, and 8 years according to treatment (Student’s t-test), and the reduction from baseline regardless of treatment (Friedman test). Secondary objectives included the proportion of patients achieving LDLc levels <55 mg/dL and <70 mg/dL at each time point according to treatment, as well as the incidence of cardiovascular events.Results Data were collected from 30 patients, 25 men (83%) with a median age of 66 years (range 46–79) and a median follow-up of 8.6 years (range 3.5–9.4). Fifteen patients (50%) received alirocumab and fifteen, evolocumab.LDLc levels decreased from 148 mg/dL at baseline to 72 mg/dL after 6 months of treatment, representing a mean reduction of 75.75 mg/dL (95% CI: 55.88–95.61; p < 0.05), which was maintained at 8 years for both treatments. Both drugs showed similar and sustained long-term efficacy in LDLc reduction (p > 0.05). (Figure 1).There were no statistically significant differences between the two treatments in the proportion of patients achieving LDLc <55 mg/dL or <70 mg/dL. (Table 1).Three cardiovascular events were observed in the group of patients treated with alirocumab and one in the evolocumab group.Abstract 4CPS-203 Table 1Abstract 4CPS-203 Figure 1Conclusion and Relevance In our cohort, both PCSK9 inhibitors achieved sustained LDLc reductions and similar proportions of patients reaching <70 and <55 mg/dL, with no significant differences between alirocumab and evolocumab, consistent with the ODYSSEY and OSLER/FOURIER studies.Conflict of Interest No conflict of interest