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Additive effects of ezetimibe, evolocumab, and alirocumab on plaque burden and lipid content as assessed by intravascular ultrasound: A PRISMA-compliant meta-analysis
Source : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9575789/
Di Liang, MPhil, a Chang Li, MPhil, a Yanming Tu, MPhil, a Zhiyong Li, Mphil, a and Ming Zhang, MD a, * The additive effects of ezetimibe, evolocumab or alirocumab on lipid level, plaque volume, and plaque composition using intravascular ultrasound (IVUS) remain unclear.
Conclusions: The addition of ezetimibe to statin therapy may further reduce plaque and lipid burdens but may not modify plaque composition. Although current evidence supports a similar impact from the addition of PCSK9 inhibitors to statin therapy, more evidence is needed to confirm such an effect.
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• Source: Medicine
• Conclusion: “The addition of ezetimibe to statin therapy may further reduce plaque and lipid burdens but may not modify plaque composition. Although current evidence supports a similar impact from the addition of PCSK9 inhibitors to statin therapy, more evidence is needed to confirm such an effect.”
• In the current systematic review and meta-analysis, researchers assessed the impact of ezetimibe, evolocumab, and alirocumab on coronary atherosclerosis using intravascular ultrasound (IVUS).
• The addition of ezetimibe did not affect plaque composition, which concurs with previous findings in the literature concerning evolocumab. The authors wrote, “In contrast, two meta-analyses showed that long-term and high-intensity statin treatment decreases fibrous tissue and increases dense calcification but does not induce significant changes in necrotic core and fibro-fatty plaque. Evolocumab and ezetimibe promote favorable effects on lipid content and plaque atheroma and improve cardiovascular outcomes but fail to improve plaque composition as assessed by IVUS.”
• Limitations of the current study include extrapolating clinical coronary disease to asymptomatic patients with subclinical atherosclerosis, as well as the majority of plaque composition analyses were pre-post comparisons of intensive lipid-lowering therapies, thus making it challenging to dissect the pathogenesis of plaque composition.