Changes in markers of subclinical atherosclerosis in patients with familial hypercholesterolemia treated with evolocumab: a prospective cohort study

Background

PCSK-9-i demonstrated efficacy in cholesterol reduction and prevention of cardiovascular events.

Purpose

Changes in lipid-profile, oxidative stress and subclinical atherosclerosis markers in patients with familial hypercholesterolemia (FH) during 12 weeks of treatment with PCSK-9-i.

Methods

Patients with FH starting a treatment with Evolocumab® were included. TC, LDL-C, Lp(a), small dense LDL (assessed byLDL score), 11-dehydro-thromboxane (11-TXB2), 8-iso-prostaglandin-2alpha (8-iso-PGF2α),FMD, RHI and carotid stiffness were evaluated at baseline and after 12weeks of treatment.

Results

25 subjects were enrolled (52% males, mean age 51.5 years). At the 12-week, the median reduction was 38% for TC, 52% for LDL-C, 7% for Lp(a) and 46% for LDL score; 11-TXB2 and 8-iso-PGF2α were reduced of 18% and 17%, respectively. FMD changed from4.78%±2.27 to10.6%±5.89 (p<0.001), with RHI changing from 2.37±1.23 to 3.76±1.36 (p<0.001). Carotid stiffness changed from 8.8 (IQR: 7.0–10.4)m/sec to 6.6 m/sec (IQR: 5.4–7.5), p<0.001). At a multivariate analysis, changes in LDL score predicted changes in FMD (β=−0.846, p=0.015) in carotid stiffness (β=0.429, p=0.041), and in 8-iso-PGF2α (β=0.778, p=0.012).

Conclusions

Small dense LDL reduction is related to changes in oxidative stress and in subclinical atherosclerosis markers in FH patients treated with Evolocumab®.

Changes in endothelial function

Funding Acknowledgement

Type of funding source: None

Correlation between different LDL-R mutations and response to ab-PCSK9 therapy in a group of patient with genetic diagnosis of Familial Hypercholesterolemia. Preliminary report

Introduction

Familial hypercholesterolemia (FH) is an autosomal dominant disease that leads to premature cardiovascular disease (CAD). The availability of ab-PCSK9 has changed the approach to therapy.

Purpose

To evaluate the relationship between different types of mutations in LDLR gene and response to ab-PCSK9.

Methods

73 FH patients, 33 women and 40 men (53.9±13. yrs), in primary prevention (N=46) and secondary prevention (N=27), were recruited. This sample included patients with mutations in LDLR gene: heterozygotes for missense mutations (N=31), for null mutations (N=31), compound heterozygotes or homozygotes (N=11). At baseline, the whole sample had a maximally tolerated lipid lowering therapy (MT-LLT) without ab-PCSK9; 16 patients had MT-LLTs intolerance. After 160 days with ab-PCSK9 therapy we evaluated the achievement of a goal (LDL-C<70 mg/dL in primary prevention without Diabetes Mellitus, LDL-C<55 mg/dL).

Results

After 160 days of therapy with ab-PCSK9 (45 patients on Alirocumab, 28 patients on Evolocumab) and MT-LLT, 29/73 patients (39.7%) of the whole sample achieve the goal of LDL-C. Of them 14/29 (48.2%) were in primary prevention, 15/29 (51.7%) in secondary prevention, no difference in achievement of the goal. We then evaluated the percent of patients achieving the goal of LDL-C:

15/31 (48.3%) patients with missense mutation and 14/31 (45.1%) patients with null mutation, no significant difference among groups;

0/11 compound heterozygotes or homozygotes;

3/16 (18.7%) MT-LLTs intolerance.

The other main cardiovascular risk factors did not influence of the achievement the goal of LDL cholesterol.

Conclusions

Lack of correlation between type of mutation in heterozygous FH patients and ab-PCSK9 therapy response; response was significantly poorest in patients with compound heterozygosis or homozygosis mutation as compared to heterozygotes; the intolerance to MT-LLT was significant in the achievement of the goal of LDL-C.

Different between guideline 2016 vs 2019

Funding Acknowledgement

Type of funding source: None