Does evolocumab added to standard of care improve lipid control and reduce major adverse cardiovascular events in patients with acute ischemic stroke and very high-risk ASCVD?
In a real-world Chinese cohort of AIS patients with very high-risk ASCVD, adding evolocumab to statin therapy significantly improved LDL-C target achievement and reduced recurrent cerebrovascular events, though it did not significantly reduce overall MACE.
Abstract Background We investigated evolocumab’s real-world effectiveness and safety on a background of statin therapy in the acute phase of ischemic stroke (IS) patients with a very high-risk of atherosclerotic cardiovascular disease (ASCVD). Methods A real-world, single-center, retrospective study was conducted in the neurology department at Tianjin Huanhu Hospital in China. Patients were divided into two groups: evolocumab treatment (140 mg every two weeks) or the standard of care (SOC) group. The primary efficacy outcome of the study was the achievement of a targeted lipid control rate and the incidence of major adverse cardiovascular events (MACE) by the end of the follow-up. Propensity score matching (PSM) analysis was utilized to account for confounding factors between groups. Survival analysises were performed using the Kaplan-Meier method. Results 1080 AIS patients with very high-risk ASCVD were recruited. After PSM, there were 528 individuals, with 206 in the evolocumab group and 322 in the standard of care (SOC) group. At 12 months of follow-up, the proportion of LDL-C < 1.4mmol/L and ≥50% reduction was 44.9% in the evolocumab group, compared with only 3.1% of SOC-treated patients ( p = 0.000). The median follow-up time for clinical events was 15 months. The evolocumab group was associated with a lower risk of cerebrovascular events compared to the SOC group (HR, 0.45; 95% CI, 0.23-0.89; p = 0.022) but did not significantly reduce the incidence of cardiovascular events (HR, 0.51; 95% CI, 0.17-1.51; p = 0.224), event-related deaths (HR, 0.71; 95% CI, 0.34-1.46; p = 0.349), or MACE (HR, 0.71; 95% CI, 0.44-1.06; p = 0.089). Conclusions This real-world study suggested that evolocumab on a background of statin reduced the LDL-C levels significantly with a well-tolerated profile and lowered the incidence of recurrent cerebrovascular events in the very high-risk ASCVD patients with AIS in China.
Zhang et al. (2023) studied this question.