Evolocumab after ACS may lower LDL within 24 hours
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Patients who were given evolocumab shortly after ACS had rapid and significant LDL reductions in 24 hours, researchers found in the EVACS trial.
“The implications for clinical practice are limited to the rapid reduction in atherogenic lipoproteins in the ACS patient population,” Thorsten M. Leucker, MD, PhD, assistant professor of medicine in the division of cardiology, director of basic and translational vascular biology research at the Ciccarone Center for the Prevention of Heart Disease and associate director of the cardiology fellowship program at Johns Hopkins University School of Medicine, told Healio. “The clinical benefits of this early, aggressive atherogenic lipoprotein-lowering approach are uncertain at this time.”
Patients with non-STEMI
In this trial published in Circulation, researchers analyzed data from 57 patients (mean age, 55 years; 42% women) with non-STEMI who had a troponin I of 5 ng/mL or greater. Patients were assigned a single 420 mg dose of evolocumab (Repatha, Amgen) subcutaneously or matching placebo. Both were administered within 24 hours of presentation.
These data were then used to determine the proportion of patients in each group who achieved LDL goals at hospital discharge and at 30-day follow-up based on AHA/ACC guidelines (< 70 mg/dL) and the ESC guidelines (< 55 mg/dL for very high risk).
Evolocumab lowered LDL by 28.4 mg/dL, on average, after adjusting for sex, baseline LDL, time, lipid-lowering therapies and site (chi-square test = 37.8; P < .0001). Patients assigned evolocumab had an LDL reduction from baseline to day 1 (70.4 mg/dL; P < .01). By day 3, LDL was lower in the evolocumab group compared with the placebo group (P = .02). The difference between both groups continued throughout hospitalization and at 30-day follow-up (P < .01).
At 30 days, patients assigned evolocumab had an LDL that was 28.6 mg/dL lower than those assigned placebo after adjusting for statin use and baseline LDL, ezetimibe use and change in statin (P < .0001). The evolocumab group also had significantly lower non-HDL and ApoB levels compared with the placebo group at 30 days. No significant differences were observed regarding HDL or triglyceride levels in both groups.
More patients assigned evolocumab achieved LDL targets according to AHA/ACC guidelines (80.8%) and ESC guidelines (65.4%) compared with those assigned placebo (38.1% and 23.8%, respectively; P for both = .01).
There were no differences in both groups for adverse or serious adverse events.
Further research
“We are currently studying the impact of PCSK9 inhibition in patients with ACS on myocardial and vascular inflammation using PET/CT sophisticated imaging modalities as well as ventricular remodeling and function using echocardiography and strain analysis,” Leucker said in an interview. “Additionally, we are investigating the basic cellular effects of evolocumab on vascular endothelial cell inflammation and function in my basic laboratory.”
For more information:
Thorsten M. Leucker, MD, PhD, can be reached at tleucke1@jhmi.edu; Twitter: @tleucker.
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