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Updated: May 7, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Evolocumab for early reduction of LDL-C levels in patients with acute ischemic stroke: a randomized controlled trial
Xiaohui Qiu1, Yeyuan Liang1, Yunfei Wei1
1Department of Neurology, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China.
Insights
Early use of evolocumab significantly lowers low-density lipoprotein cholesterol (LDL-C) in acute ischemic stroke (AIS) patients. This treatment, added to standard care, proved safe and effective in achieving target LDL-C levels within 8 weeks.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Pharmacology
Background:
- Low-density lipoprotein cholesterol (LDL-C) is a key risk factor for acute ischemic stroke (AIS).
- Achieving target LDL-C levels with standard in-hospital statin therapy in AIS patients is often challenging.
- The efficacy and safety of early evolocumab use in the acute phase of AIS require further investigation.
Purpose of the Study:
- To evaluate the LDL-C reduction efficacy of early-phase in-hospital administration of evolocumab in AIS patients.
- To assess the safety profile of evolocumab when used concurrently with standard care in AIS patients.
- To determine the rate of achieving targeted LDL-C levels with early evolocumab intervention.
Main Methods:
- A single-center, prospective, unblinded randomized controlled trial was conducted.
- 120 hospitalized AIS patients were randomized 1:1 to receive evolocumab (420 mg every 4 weeks) plus standard of care (atorvastatin 40 mg/day and ezetimibe 10 mg/day) or standard of care alone for 8 weeks.
- Primary outcomes included absolute change in LDL-C levels and the proportion of patients achieving target lipid control (<1.4 mmol/L) at 8 weeks.
Main Results:
- The evolocumab group showed a mean LDL-C reduction from 3.15 mmol/L to 0.85 mmol/L, compared to 3.17 mmol/L to 2.22 mmol/L in the control group.
- The mean change in LDL-C from baseline at 8 weeks was significantly greater in the evolocumab group (-1.37, p < 0.001).
- A significantly higher proportion of patients achieved target LDL-C levels in the evolocumab group (81.67%) versus the control group (13.33%). Adverse events were comparable between groups.
Conclusions:
- Early application of evolocumab, in addition to high-intensity statin and ezetimibe therapy, significantly reduces LDL-C levels in patients with acute ischemic stroke.
- This therapeutic approach was well-tolerated and effective in achieving target lipid levels during the early phase of AIS.
- The findings support the consideration of early evolocumab therapy for lipid management in AIS patients.
Background:
Low-density lipoprotein cholesterol (LDL-C) has been determined as an established risk factor for acute ischemic stroke (AIS). Despite the recommendation for in-hospital initiation of high-intensity statin therapy in AIS patients, achieving the desired target LDL-C levels remains challenging. Evolocumab, a highly effective and quickly acting agent for reducing LDL-C levels, has yet to undergo extensively exploration in the acute phase of AIS. The aim was to assess the LDL-C reduction efficacy and safety of early application of evolocumab during the in-hospital phase of AIS patients.
Methods:
An unblinded, single-center, prospective randomized controlled trial involving hospitalized AIS patients was conducted in the Second Affiliated Hospital of Guangxi Medical University in China. Patients were randomly assigned 1:1 to receive evolocumab 420 mg every 4 weeks or not, on top of standard of care (SOC) treatment (atorvastatin 40 mg/day and ezetimibe 10 mg/day), administered in-hospital until after 8 weeks. The primary outcome was the absolute change of LDL-C levels and the rate of achieving targeted lipid control at 8 weeks.
Results:
Totally, 120 patients were recruited from January 2023 to December 2023. Mean LDL-C levels decreased from 3.15 mmol/L to 0.85 mmol/L in the evolocumab group, and from 3.17 mmol/L to 2.22 mmol/L in the control group, with the difference in mean change from baseline was -1.37 [95% confidence interval (CI) = -1.70 to -1.04, p < 0.001] at week 8. The rate of patients achieving targeted LDL-C <1.4 mmol/L was 81.67% in evolocumab group as compared with 13.33% in control group. Adverse events were similar in both groups.
Conclusion:
Our study indicated that evolocumab added to high-intensity statin and ezetimibe therapy resulted in substantial reduction in LDL-C levels in early AIS patients and was well tolerated.
Clinical Trial Registration:
ClinicalTrials.gov, identifier NCT05697185.
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