Effects of evolocumab combined with statin therapy on blood lipids, inflammatory factors, and endothelial function in patients with coronary heart disease

Coronary heart disease (CHD) remained a leading cause of morbidity and mortality, necessitating innovative treatment strategies. This study aimed to evaluate the efficacy and safety of evolocumab combined with atorvastatin compared to atorvastatin monotherapy in patients with CHD. This retrospective cohort study included CHD patients admitted between February 2023 and April 2024. Patients were divided into two groups: the Monotherapy Group received atorvastatin alone (75 patients) and the Combination Therapy Group received both evolocumab and atorvastatin (76 patients) for a duration of three months. Lipid profiles, inflammatory markers, and endothelial function parameters were assessed before and after treatment completion. In the Combination Therapy Group, significant improvements were observed in total cholesterol (2.65 ± 0.77 mmol/L vs. 2.27 ± 0.76 mmol/L, P = 0.002), low-density lipoprotein cholesterol (1.71 ± 0.49 mmol/L vs. 1.08 ± 0.32 mmol/L, P < 0.001), and apolipoprotein B (0.49 ± 0.16 g/L vs. 0.42 ± 0.13 g/L, P = 0.004). Inflammatory markers interleukin-1β and tumor necrosis factor-α also decreased significantly in the Combination Therapy Group. Endothelial function improved, as indicated by flow-mediated dilation (5.01 ± 1.67% vs. 4.27 ± 1.32%, P = 0.003) and vascular activity range (4.20 ± 1.39 mm vs. 3.68 ± 1.22 mm, P = 0.017). The incidence of adverse cardiovascular events was lower in the Combination Therapy Group (3.95% vs. 14.67%, P = 0.023). Compared to statin monotherapy, the combination of evolocumab with atorvastatin synergistically improved lipid control, reduced early inflammation, enhanced endothelial function, and decreased cardiovascular events.