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. 2022 May 6:9:907662.
doi: 10.3389/fcvm.2022.907662. eCollection 2022.

Effect of Alirocumab on Coronary Calcification in Patients With Coronary Artery Disease

Fei Gao  1 , Yue Ping Li  1 , Xiao Teng Ma  1 , Zhi Jian Wang  1 , Dong Mei Shi  1 , Yu Jie Zhou  1
Affiliations

Effect of Alirocumab on Coronary Calcification in Patients With Coronary Artery Disease

Fei Gao et al. Front Cardiovasc Med. .

Abstract

Background: Proprotein convertase subtilisin kexin type 9 (PCSK9) inhibitors have been documented with significantly reduction in LDL cholesterol levels and cardiovascular events. However, evidence regarding the impact of PCSK9 inhibitors on coronary calcification is limited.

Methods: Eligible patients with intermediate coronary lesions and elevated LDL cholesterol values were randomized to either alirocumab 75 mg Q2W plus statin (atorvastatin 20 mg/day or rosuvastatin 10 mg/day) therapy or standard statin therapy. Calcium score based on coronary computed tomographic angiography at baseline and follow up were compared.

Results: Compared with baseline levels, LDL cholesterol were significantly decreased in both groups, while the absolute reduction of LDL cholesterol levels were higher in patients treated with alirocumab (1.69 ± 0.52 vs. 0.92 ± 0.60, P < 0.0001). Additionally, patients in alirocumab group demonstrated a significant reduction of Lp(a) levels, whereas it was not observed in the standard statin group. Notably, greater increases in the percentage changes of CAC score (10.6% [6.3-23.3] vs. 2.9% [-6.7-8.3]; P < 0.0001) were observed in the statin group compared to the alirocumab group. Consistently, CAC progression was significantly lower in the alirocumab group than in the standard statin group (0.6 ± 2.2% vs. 2.7 ± 2.3%; P = 0.002).

Conclusions: Study indicated that administration of the PCSK9 inhibitors to statins produced significantly lower rate of CAC progression in patients with coronary artery disease. Further studies with CAC progression and their clinical outcomes are needed.

Trial registration: ClinicalTrials.gov, Identifier: NCT04851769.

Keywords: PCSK9 inhibition therapy; alirocumab; coronary artery disease; coronary calcification; statin.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Comparison of coronary artery calcium (CAC) score between the baseline and follow-up in the alirocumab (N = 23). CAC scores between baseline and follow-up were compared with the Wilcoxon signed-rank test.
Figure 2
Figure 2
Comparison of coronary artery calcium (CAC) score between the baseline and follow-up in the statin (N = 28) group. CAC scores between baseline and follow-up were compared with the Wilcoxon signed-rank test.
Figure 3
Figure 3
Comparison of percentage change in coronary artery calcium (CAC) score between the alirocumab (N = 23) and the statin (N = 28) group. Percentage changes of CAC score between the statin group and the PCSK9 inhibitor group were compared with the Mann–Whitney U test.
See this image and copyright information in PMC

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