Key result
PCSK9 inhibitor therapy for 12 months did not significantly change aortic stiffness (PWV 10.6 vs 10.6 m/s, p=0.124), endothelial function, or arterial structure despite significant LDL-C reduction.
Why the study?
Only a few studies have evaluated whether the reduction in cardiovascular events by PCSK9 inhibitors is determined by an improvement in arterial functional and structural parameters.
Does PCSK9 inhibitor therapy improve arterial structural and functional properties in high-risk cardiovascular patients?
Cohort (n=84)
No
Does PCSK9 inhibitor therapy improve arterial structural and functional properties in high-risk cardiovascular patients?
Absolute Event Rate: 10.6% vs 10.6%
p-value: p=0.124
PCSK9 inhibitor therapy significantly reduces LDL-C but does not significantly alter arterial stiffness, structure, or endothelial function over 12 months, though stability may suggest halted progression of atherosclerosis.
No vascular benefit expected from PCSK9 inhibitors in routine care; leaves open whether longer exposure or randomized trials would reveal structural effects.
Background Proprotein Convertase Subtilisin/Kexin type 9 (PCSK9) inhibitor antibodies reduce the frequency of new cardiovascular (CV) events through Low–Density Lipoprotein Cholesterol (LDL–C) reduction and plaque stabilisation. However, only a few studies have evaluated whether this effect is also determined by an improvement in arterial functional and structural parameters. We aimed to evaluate aortic stiffness (carotid–femoral Pulse Wave Velocity – PWV), arterial structure (carotid Intima–Media Thickness – IMT), and endothelial function (brachial Flow Mediated Dilatation – FMD) in patients treated with Alirocumab and Evolocumab. Methods This is a monocentric, prospective, longitudinal study on patients who received antibody–based PCSK9–i therapy at the cardiac rehabilitation and CV prevention outpatient clinic of our hospital. All patients starting a PCSK9–i on a clinical basis were enrolled and underwent PWV, FMD, and IMT measurement at three timepoints: the same day of the first injection (T0), after 6 months (T1), and after 12 months (T2). Results 84 patients concluded the 12–months period. The population’s mean age was 67±8.2 years, and most of them were male (70.2%). LDL–C had a significant reduction during the follow–up (117.6±35.6 vs 37.5±26.2 mg/dL, p‹0.001). However, there were no significant changes in PWV (10.6±2.8 vs 10.6±2.3 m/s, p=0.124 ), FMD (7.0±8.6 vs 8.3±10.8%, p=0.474 ) and IMT (719.2±184.9 vs 740.9±170.2 μm, p=0.386) values. Conclusions In our population, PCSK9 inhibitors showed neither significant benefits nor changes in vascular properties; however, the stability of these parameters may indicate a deceleration in the progression of atherosclerotic disease, which might otherwise have worsened in this high–risk population.
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Bellomare et al. (2026) conducted a cohort in High cardiovascular risk (n=84). PCSK9 inhibitors (Alirocumab and Evolocumab) vs. Baseline was evaluated on Aortic stiffness (carotid-femoral Pulse Wave Velocity - PWV) (p=0.124). PCSK9 inhibitor therapy for 12 months did not significantly change aortic stiffness (PWV 10.6 vs 10.6 m/s, p=0.124), endothelial function, or arterial structure despite significant LDL-C reduction.
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