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Evolocumab reduces LDL particle sizes in hyperlipidemia
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Patients with hyperlipidemia treated with evolocumab had a greater reduction in atherogenic lipoprotein particles compared with those who received placebo, according to a post hoc subanalysis published in The American Journal of Cardiology.
Peter P. Toth, MD, PhD, FAHA, FESC, FACC, director of preventive cardiology at CGH Medical Center in Sperling, Illinois; professor of clinical family and community medicine at University of Illinois College of Medicine in Peoria; and professor of medicine at Michigan State University College of Osteopathic Medicine in East Lansing, and colleagues analyzed data from 619 patients with hyperlipidemia from the DESCARTES trial. In this 52-week trial, patients had a fasting triglyceride level less than 4.5 mmol/L and LDL level greater than 1.9 mmol/L after a run-in period with lipid-lowering therapy. Patients were assigned to 420 mg per month evolocumab (Repatha, Amgen; n = 336; mean age, 56 years; 49% women) or placebo (n = 283; mean age, 57 years; 56% women).
VLDL, serum concentration levels of lipoprotein particles and remnant lipoproteins and their particle sizes were measured with nuclear magnetic resonance spectroscopy.
The mean LDL-particle concentration at baseline was 1,077.1 nmol/L in the placebo group and 1,100.2 nmol/L in the evolocumab group.
At 52 weeks, LDL-particle concentration decreased to 610 nmol/L in patients assigned evolocumab with a treatment difference of 50% compared with those assigned placebo. Small VLDL particles (–29%), intermediate-density lipoprotein particles (–36%) and medium VLDL particles (–15.2%) were also reduced in patients assigned evolocumab.
Total LDL particle size decreased by a mean of 1.7% in the evolocumab group (95% CI, –2 to –1.4). HDL particle sizes increased by 1.1% (95% CI, 0.7-1.5) and VLDL particle sizes increased by 8.7% (95% CI, 7-10.5) in patients assigned evolocumab.
Significant changes in total HDL, VLDL and HDL particle sizes were seen in the evolocumab group compared with the placebo group (P < .001 for all).
“The effect of evolocumab on lipoprotein particle number and size were consistent regardless of concordance at baseline and regardless of whether the patient had diabetes, impaired fasting glucose or metabolic syndrome,” Toth and colleagues wrote. “If LDL-C and LDL-P values are discordant, LDL-P levels may be important to consider when assessing cardiovascular risk. This could be important in patients with diabetes who may be more likely to have discordance. Thus, there may be clinical importance in quantifying the effects of any lipid-lowering therapy on LDL-P as well as LDL-C.” – by Darlene Dobkowski
Disclosures: Toth reports he receives consultant fees from Amarin, Amgen, AstraZeneca, Gemphire, Kowa, Merck and Sanofi/Regeneron and serves on speakers bureaus for Amarin, Amgen, Kowa, Merck and Regeneron-Sanofi. Please see the study for all other authors’ relevant financial disclosures.
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