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Factors correlated with non-early achievement of target low-density lipoprotein cholesterol level using PCSK9
Masami Nishino1, Yasuyuki Egami2, Ayako Sugino2
1Division of Cardiology, Osaka Rosai Hospital, 3-1179 Nagasonecho, Kita-ku, Sakai, Osaka, 591-8025, Japan. mnishino@osakah.johas.go.jp.
Insights
Very-high-risk patients on PCSK9 inhibitors may not achieve early LDL-c reduction, especially those with a history of acute coronary syndrome (ACS) or higher baseline LDL-c. Careful monitoring is crucial for these individuals.
Area of Science:
- Cardiology
- Pharmacology
- Metabolic Disorders
Background:
- International guidelines advocate for very low-density lipoprotein cholesterol (LDL-c) targets (<55 mg/dL) in very-high-risk patients.
- Early LDL-c reduction is particularly emphasized for acute coronary syndrome (ACS) patients.
- Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors effectively lower LDL-c, but some patients experience delayed achievement of target levels.
Purpose of the Study:
- To identify factors associated with delayed LDL-c reduction in very-high-risk patients treated with PCSK9 inhibitors.
- To understand predictors of non-early achievement of target LDL-c levels.
Main Methods:
- A cohort of very-high-risk dyslipidemia patients receiving evolocumab was analyzed.
- Patients were categorized into early achievement (EAC) and non-early achievement (non-EAC) groups based on LDL-c <55 mg/dL at 1 month.
- Univariable and multivariable analyses were performed to identify correlating factors.
Main Results:
- 35.2% of patients (25/71) did not achieve early LDL-c target.
- Univariable analysis linked higher BMI, ACS history, higher baseline LDL-c (>144 mg/dL), and high-intensity statins to non-EAC.
- Multivariable analysis identified ACS history as a negative predictor and baseline LDL-c >144 mg/dL as a positive predictor of non-EAC.
Conclusions:
- A history of ACS and higher baseline LDL-c levels are significant factors for delayed LDL-c reduction with PCSK9 inhibitors.
- More aggressive PCSK9 inhibitor induction and close follow-up are warranted for ACS patients, particularly those with elevated baseline LDL-c.
Abstract:
The international guidelines recommend a target low-density lipoprotein cholesterol (LDL-c) level of < 55 mg/dL in very-high-risk patients with dyslipidemia, which were defined as those with history of acute coronary syndrome (ACS), chronic coronary syndrome with multivessel disease, diabetes mellitus, chronic kidney disease, familiar hypercholesterolemia, recurrent coronary artery disease, or polyvascular disease. In addition, an early reduction in LDL-c levels is recommended especially for ACS. Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have been reported to be very effective for an early reduction in the LDL-c level, but some patients showed non-early reduction. We investigated the factors correlating with non-early lowering LDL-c levels using PSCK9 inhibitors in very-high-risk patients. We enrolled consecutive patients with dyslipidemia who received evolocumab due to very-high-risk. We divided them into the early achievement of the target LDL-c level (EAC) group whose LDL-c level decreased to < 55 mg/dL 1 month later and the non-EAC group. We investigated the various factors possibly correlated with non-EAC. The non-EAC group comprised 25 patients (35.2%). A univariable analysis revealed that a body mass index (BMI) > 23.9 kg/m2, history of ACS, LDL-c > 144 mg/dL, and high-intensity statins were related to the non-EAC group. A multivariable analysis showed that a history of ACS was negatively and LDL cholesterol level > 144 mg/dL positively correlated with non-EAC. In conclusion, we induced PSCK9 inhibitors more aggressively in ACS, and we should pay attention to the patients with higher baseline LDL-c levels during the follow-up.
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