|PCSK9 antibodies decrease the risk of relapsed ischemic cardiovascular events|
|Proprotein convertase subtilisin-kexin type 9 (PCSK9) degrades of low-density lipoprotein (LDL) receptors, which bind to LDL to promote clearance of circulating LDL. Therefore, reduced levels of PCSK9 inhibit LDL receptor degradation, which subsequently reduces circulating LDL concentrations in the bloodstream. It has been reported acute coronary syndrome patients with lower concentrations of LDL have reduced risks of recurrent ischemic cardiovascular disease. In a recent NEJM paper (here), the team led by Dr. Schwartz determined the efficacy of PCSK9 antibodies in prevention of recurrent ischemic cardiovascular events.
In this multicentre, randomized, double-blind, placebo-control trial, a total of 18,924 patients who experienced an acute coronary syndrome were recruited, among whom 9462 patients were assigned to the PCSK9 antibody (alirocumab, 75mg, subcutaneous injection every 2 weeks) group and 9462 patients were assigned to the control group. The majority of patients (88.8%) were prescribed high-intensity doses of statins to control LDL levels. The primary endpoint was a composite of death related to coronary heart disease, nonfatal myocardial infarction, stroke, or unstable angina requiring hospitalization.
After a median follow-up of 2.8 years, 9.5% of patients in the PCSK9 antibody group reached the endpoint, whereas 11.1% of individuals in the placebo group experienced the endpoint (hazard ratio, 0.85, 95%CI, 0.78 to 0.93, p<0.001). All patients in both groups had similar levels of LDL when randomized, but those in the PCSK9 group had lower levels of LDL at 4, 12, and 48 months after randomization. The incidence of adverse events was comparable between two groups.
PCSK9 antibodies combined with high-intensity doses of statins reduces the risk of recurrent coronary heart disease.
This study was supported by a pharmaceutical company.