Title:Efficacy and Safety of Evolocumab in Reducing Low-Density Lipoprotein Cholesterol Levels in Chinese Patients with Non-ST-segment Elevation Acute Coronary Syndrome
Volume: 19
Issue: 4
Author(s): Xiaohan Xu, Meng Chai, Yujing Cheng, Pingan Peng, Xiaoli Liu, Zhenxian Yan, Yonghe Guo, Yingxin Zhao and Yujie Zhou*
Affiliation:
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Centre for Coronary Heart Disease, Capital Medical University, Beijing 100029,China
Keywords:
Evolocumab, non-ST-segment elevation acute coronary syndrome, low-density lipoprotein cholesterol, ASCVD,
ACS, clinical benefit.
Abstract:
Aims: This study aims to explore early intensive lipid-lowering therapy in patients with non-
ST-segment elevation acute coronary syndrome (NSTE-ACS).
Background: Lowering low-density lipoprotein cholesterol (LDL-C) levels can reduce cardiovascular
morbidity and mortality in patients with atherosclerotic cardiovascular disease. Due to many reasons,
the need for early intensive lipid-lowering therapy is far from being met in Chinese NSTE-ACS patients
at high risk of recurrent ischaemic events.
Objective: This study evaluates the feasibility, safety and efficacy of starting evolocumab in hospitals to
lower LDL-C levels in Chinese patients with NSTE-ACS.
Methods: In this prospective cohort study initiated by researchers, 334 consecutive patients with NSTEACS
who had sub-standard LDL-C levels (LDL-C ≥2.3 mmol/L after regular oral statin treatment for at
least 4 weeks; or LDL-C ≥3.2 mmol/L without regular oral statin treatment) were included. Patients
who agreed to treatment with evolocumab (140 mg subcutaneously every 2 weeks, initiated in hospital
and used for 12 weeks after discharge) were enrolled in the evolocumab group (n=96) and others in the
control group (n=238). All enrolled patients received regular statin treatment (atorvastatin 20 mg/day or
rosuvastatin 10 mg/day; doses unchanged throughout the study). The primary endpoint was the change
in LDL-C levels from baseline to week 12.
Results: Most patients (67.1%) had not received regular statin treatment before. In the evolocumab
group, LDL-C levels decreased significantly at week 4 and remained stable at week 8 and 12 (all
p<0.001). At week 12, the LDL-C percentage change from baseline in the evolocumab group was -
79.2±12.7% (from an average of 3.7 to 0.7 mmol/L), while in the control group, it was -37.4±15.4%
(from an average of 3.3 to 2.0 mmol/L). The mean difference between these 2 groups was -41.8% (95%
CI -45.0 to -38.5%; p<0.001). At week 12, the proportion of patients with LDL-C levels <1.8 mmol/L
and 1.4 mmol/L in the evolocumab group was significantly higher than in the control group (96.8 vs
36.1%; 90.6 vs 7.1%; both p<0.001). The incidences of adverse events and cardiovascular events were
similar in both the groups.
Conclusion: In this prospective cohort study, we evaluated the early initiation of evolocumab in NSTEACS
patients in China. Evolocumab combined with statins significantly lowered LDL-C levels and
increased the probability of achieving recommended LDL-C levels, with satisfactory safety and good
tolerance.
