PCSK9 Inhibitor Reduces Ischemic CV Event Risk

In patients with previous acute coronary syndrome (ACS), adding alirocumab to high-intensity statin therapy was associated with a reduction in the risk of recurrent ischemic cardiovascular events, according to the results of a recent study.

Patients with a history of ACS are at increased risk of future ischemic cardiovascular events. In order to examine whether adding alirocumab, a human monoclonal antibody to proprotein convertase subtilisin-kexin type 9 (PCSK9), would improve cardiovascular outcomes in these patients, researchers conducted a multicenter, randomized, double-blind, placebo-controlled trial involving 18,924 patients.

The participants had had an acute coronary syndrome 1 to 12 months before baseline, had low-density lipoprotein (LDL) cholesterol level of 70 mg/dL, a non-high-density lipoprotein cholesterol level of 100 mg/dL, or an apolipoprotein B level of 80 mg/dL, and were receiving high-intensity statin therapy.

They were randomly assigned to either alirocumab (75 mg) or matching placebo, given subcutaneously every 2 weeks.

A primary end-point event (death from coronary heart disease, nonfatal myocardial infarction, fatal or nonfatal ischemic stroke, or unstable angina requiring hospitalization) occurred in 903 patients (9.5%) within the alirocumab group and 1052 (11.1%) in the placebo group, with 334 and 392 deaths, respectively. The benefits of alirocumab were observed to be greater among those with baseline LDL cholesterol of 100 mg/dL or more than among those with a lower baseline level.

“In conclusion, among patients who had a previous ACS and whose levels of atherogenic lipoproteins remained elevated despite statin therapy at a high-intensity dose or at the maximum tolerated dose, the risk of major adverse cardiovascular events was lower among those who were treated with alirocumab than among those who received placebo.”

—Michael Potts

Reference:

Schwartz GG, Steg G, Szarek M, et al. Alirocumab and cardiovascular outcomes after acute coronary syndrome [published online November 7, 2018]. N Engl J Med. https://doi.org/10.1056/nejmoa1801174.