Early evolocumab helps reduce LDL-C levels, prevent recurrent ischaemic cardiovascular events

In acute coronary syndrome (ACS) patients who have undergone percutaneous coronary intervention (PCI), early treatment with evolocumab as an addition to statin can lower low-density lipoprotein cholesterol (LDL-C) levels as well as reduce the incidence of recurrent ischemic cardiovascular events, while having satisfactory tolerability and safety, according to a study.

The study included 1,564 consecutive ACS patients who had been hospitalized and underwent PCI. All patients had elevated LDL-C levels despite statin treatment (≥1.8 mmol/L after receiving high-intensity statin for ≥4 weeks; ≥2.3 mmol/L after receiving low- or moderate-intensity statin; or ≥3.2 mmol/L without statin therapy).

Of the patients, 414 received evolocumab (initiated in-hospital and after 18 months) while 1,150 did not. The primary outcome of a composite of ischaemic cardiovascular events (ischemic stroke, cardiovascular death, myocardial infarction, hospitalization for unstable angina, or coronary revascularization) at 18 months occurred less frequently in the evolocumab than in the control group (8.2 percent vs 12.4 percent; adjusted hazard ratio, 0.65, 95 percent confidence interval, 0.45–0.95; p=0.025). This benefit was consistently observed across the major subgroups.

Furthermore, early initiation of evolocumab reduced LDL-C levels from baseline levels by 42.48 percent compared with statins alone.

In terms of safety, there were no significant between-groups differences observed in any adverse events.