Key Points
• Source: Atherosclerosis Plus
• Conclusion: “These data show that for patients with CAD and high Lp(a) levels, beneficial effects of PCSK9 inhibitors on the arterial wall properties can be attenuated by specific risk factors, such as smoking and diabetes.”
• In the current study, Slovenian researchers randomized 100 CAD patients with high Lp(a) levels who experienced MI before aged 55 years to 3 groups: 1) lipid-lowering therapies sans PCSK9 inhibitors; 2) treatment with alirocumab 150 mg SC every 2 weeks; and 3) treatment with evolocumab 140 mg SC every 2 weeks.
• The authors wrote, “In this study, we investigated the effects of alirocumab and evolocumab treatments in addition to standard treatments on the morphological and functional properties of the arterial wall in patients with premature and stable CAD and very high Lp(a) levels. Overall, there were no differences in the effects on lipids and lipoproteins between alirocumab and evolocumab. On the other hand, with FMD [flow-mediated dilation] as an indicator of the functional properties of the arterial wall and c-IMT [carotid intima-media thickness] and PWV [pulse-wave velocity] as indicators of the morphological properties of the arterial wall, these were only improved after treatment with evolocumab.”
• Alirocumab and evolucomab lowered total cholesterol and LDL-C by >60%, along with decreasing triglycerides, Lp(a), and apoB, which aligns with results from previous studies.
• Limitations of the current study include it being single-bind randomized vs. double-blind randomized and it being low (but adequate) power.