Impact of alirocumab on achieving ldl-cholesterol targets in secondary prevention: real-world evidence

Background/Introduction Patients in secondary prevention frequently fail to achieve guideline LDL-C targets despite maximally tolerated statin therapy. Alirocumab has shown substantial LDL-C reductions in clinical trials, but additional data from clinical practice are valuable. Purpose To assess LDL-C target attainment, effectiveness and tolerability of alirocumab in secondary prevention patients with persistently elevated LDL-C. Methods A retrospective observational study included individuals in secondary prevention whose LDL-C levels remained >100 mg/dL despite statin ± ezetimibe therapy. Alirocumab was added to current treatment. LDL-C levels before and after initiation, adherence, tolerability, and cardiovascular events were collected. Results Fifty-two patients were included. The median follow-up was 35 months. Alirocumab produced a mean LDL-C reduction of 69.2%. No patient met LDL-C <55 mg/dL at baseline; after treatment, 80.8% achieved this target. Dosing was 75 mg in 52% and 150 mg in 48%. Adherence was high, with no treatment discontinuations. No relevant adverse effects leading to withdrawal were reported. Seven cardiovascular events occurred: 1 myocardial infarction, 2 heart failure admissions, and 4 unstable angina cases requiring coronary revascularisation; no stroke or cardiovascular deaths were observed. Conclusions In secondary prevention patients with persistently elevated LDL-C, the addition of alirocumab enabled a high rate of LDL-C target attainment with sustained lipid improvement. Favourable adherence and tolerability support the use of PCSK9 inhibition to optimise lipid control in patients who do not achieve recommended LDL-C levels with conventional therapy.