Abstract
BackgroundTo assess the effects of proprotein convertase subtilisin/kexin type 9 inhibitor (evolocumab) on lipoprotein particles subfractions with Nuclear Magnetic Resonance spectroscopy in patients with acute coronary syndromes.MethodsA total of 99 consecutive patients with ACS were enrolled and assigned to either the experimental group (n = 54) or the control group (n = 45). The combination therapy of PCSK9 inhibitor (Repatha®, 140 mg, q2w) and moderate statin (Rosuvastatin, 10 mg, qn) was administered in the experimental group, with statin monotherapy (Rosuvastatin, 10 mg, qn) in the control group. The therapeutic effects on lipoprotein particle subfractions were assessed with NMR spectroscopy after 8 weeks treatment, and the achievement of LDL-C therapeutic target in both groups were analyzed.ResultsIn the experimental group, after 8 weeks of evolocumab combination treatment, the concentrations of blood lipids (TC, LDL-C and its subfractions [LDL-1 to 6], VLDL-C and its subfractions [VLDL-1 to 5], IDL-C, and HDL-C), lipoprotein particles, and their subfractions [VLDL-P, IDL-P, LDL-P, and its subfractions [LDL-P1 to 6], apoB, and LP(a)] demonstrated therapeutic benefits with statistical significance (P < 0.05). The decrease in total LDL-P concentrations was mainly due to a decreased concentration of small-sized LDL particles (LDL-P 5 + 6), which was significantly more prominent than the decrease in medium-sized LDL-P (LDL-P3 + 4) and large-sized LDL-P (LDL-P1 + 2) (P < 0.001). According to lipid control target recommended by the latest China Cholesterol Education Program Expert Consensus in 2019, after 8 weeks treatment, 96.3% patients in the experimental group and 13.3% in the control group had achieved the LDL-C therapeutic target (P < 0.01).ConclusionsEvolocumab combination treatment for 8 weeks significantly improves the plasma lipid profiles in ACS patients, and significantly decrease the concentration of lipoprotein particles which might contribute to the pathonesis of atherosclerosis.
Highlights
To assess the effects of proprotein convertase subtilisin/kexin type 9 inhibitor on lipoprotein particles subfractions with Nuclear Magnetic Resonance spectroscopy in patients with acute coronary syndromes
LDL particles of different sizes might not play the same role in the progression of atherosclerosis [8], indicating that the subfractions of LDL particles closely correlates with their functions, which is of grander clinical significance [9,10,11]
acute coronary syndromes (ACS) patients who presented to the Tianjin Chest Hospital from May to December 2019 were enrolled, with the inclusion criteria as follows: (1) Informed consent obtained from the participant who voluntarily take the medications, and related documents signed; (2) Patients aged 18 years and older presenting within 72 h after pain onset associated with either one of the following primary diagnoses: ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI) or unstable angina pectoris (UAP)
Summary
To assess the effects of proprotein convertase subtilisin/kexin type 9 inhibitor (evolocumab) on lipoprotein particles subfractions with Nuclear Magnetic Resonance spectroscopy in patients with acute coronary syndromes. Low-density lipoprotein cholesterol (LDL-C) is the primary target of therapy in patients with acute coronary syndromes (ACS) in guidelines worldwide [1, 2]. Statins are the first choice for lipid-lowering agents in clinical applications, which could effectively decrease the risk of cardiovascular diseases. Novel lipid-lowering agents, proprotein convertase subtilisin/ kexin type 9(PCSK9) inhibitors, are receiving more attention, and impressive progresses were made in relevant studies. With the conclusion of a series of clinical trials, PCSK9 inhibitors are gradually proven to be effective in lowering blood lipid levels and preventing cardiovascular diseases [12]
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