Key result
In patients with acute coronary syndromes and poor lipid control, the addition of evolocumab to a moderate statin for 8 weeks significantly increased the rate of achieving LDL-C treatment targets compared to statin monotherapy (96.3% vs 13.3%, P<0.001).
Why the study?
The effects of PCSK9 inhibitor on blood lipid levels, lipoprotein particles, and their subfractions in ACS patients with poor lipid control were not well characterized.
Cohort (n=99)
No
ObjectiveTo assess the effects of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor (evolocumab) on blood lipid level, lipoprotein particles, and their subfractions with Nuclear Magnetic Resonance (NMR) spectroscopy in patients with acute coronary syndromes(ACS). MethodsA total of 99 consecutive patients with ACS and poor lipid control were enrolled and assigned to either the experimental group (n = 54) or the control group (n = 45). The combination therapy of PCSK9 inhibitor (Repatha®, 140mg, q2w) and moderate statin (rosuvastatin, 10 mg, qn) was administered in the experimental group, with moderate statin therapy (rosuvastatin, 10 mg, qn) alone in the control group. The therapeutic effects on blood lipid levels and lipoprotein particle subfractions were assessed with NMR spectroscopy after eight weeks of treatment, and the achievement of LDL-C treatment target in both groups was analyzed. ResultsIn the experimental group, after eight weeks of evolocumab and moderate statin combination therapy, the level of blood lipids (TC, LDL-C and its subfractions [LDL-1 to 6], VLDL-C and its subfractions [VLDL-1 to 5], IDL-C, and HDL-C), lipoprotein particles, and their subfractions (VLDL-P, IDL-P, LDL-P, and its subfractions [LDL-P1 to 6], apoB, and LP(a)) demonstrated therapeutic benefits with statistical significance (P < 0.05). Lowered level of LDL-P was attributed to the significant decrease of small LDL-P (LDL-P5+6), which was significantly more prominent than the decrease in medium LDL-P (LDL-P3+4) and large LDL-P (LDL-P1+2) (P < 0.001). According to lipid control target recommended by the latest China Cholesterol Education Program (CCEP) Expert Consensus in 2019, the percentage of patients reaching the treatment target differed significantly between the experimental group and the control group (96.3% and 13.3%, respectively, P < 0.001). ConclusionsPCSK9 inhibitor treatment for 8 weeks could significantly improve the plasma lipid profiles in ACS patients with poor lipid control, and significantly decrease the concentration of lipoprotein particles which could result in atherosclerosis.
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Li et al. (2020) conducted a cohort in Acute Coronary Syndromes with poor lipid control (n=99). Evolocumab (PCSK9 inhibitor) + moderate statin vs. Rosuvastatin 10 mg qn alone was evaluated on Achievement of LDL-C treatment target (<55 mg/dL or ≥50% reduction from baseline) (p=<0.001). In patients with acute coronary syndromes and poor lipid control, the addition of evolocumab to a moderate statin for 8 weeks significantly increased the rate of achieving LDL-C treatment targets compared to statin monotherapy (96.3% vs 13.3%, P<0.001).
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