EVOLOCUMAB, a PCSK-9-inhibitor, treatment improves endothelial function, specifically by increasing the vasoactive range in patients with cardiovascular disease, recent research has revealed.
The aim of this study was to assess the effect of evolocumab on endothelial function in patients with preexisting cardiovascular disease (CVD) receiving statin therapy. Endothelial dysfunction is a key factor in the pathogenesis of cardiovascular events, and improving endothelial function may reduce the risk of adverse outcomes. Evolocumab, a monoclonal antibody targeting PCSK9, has previously been shown to lower LDL cholesterol, but its impact on endothelial function in this context had not been fully evaluated. This study was designed to fill that gap by evaluating changes in various parameters of endothelial function.
This was a prospective, double-blinded, randomized, controlled, single-centre study, which included 103 patients with a mean age of 66.2 years, all of whom had cardiovascular disease and were being treated with statins. Patients were randomly assigned to receive either evolocumab or a placebo, and endothelial function was assessed at baseline, and after 1, 4, and 8 weeks using a high-resolution ultrasound system (UNEX EF 18G). Key parameters measured included flow-mediated vasodilation (FMD), low-flow-mediated vasoconstriction (L-FMC), and vasoactive range (VAR). At the conclusion of the study, VAR had significantly improved in the evolocumab group compared to the placebo (p=0.045), with a notable increase from baseline to week 8 (p=0.034). However, no significant changes were observed in FMD or L-FMC. Subgroup analyses revealed that VAR improvements were particularly notable in patients who were younger, had lower systolic blood pressure, and had higher baseline LDL cholesterol levels. Importantly, no serious adverse events related to the study medication occurred.
In conclusion, evolocumab treatment was associated with an improvement in endothelial function, particularly in terms of the vasoactive range, in high-risk cardiovascular patients already on statin therapy. These findings suggest that evolocumab may have a beneficial impact on endothelial health, which may contribute to the observed reductions in cardiovascular events seen in larger trials such as FOURIER. Future studies could explore the long-term clinical implications of these findings and assess whether this endothelial benefit translates into a reduction in cardiovascular events. This study adds to the growing body of evidence supporting the use of evolocumab in high-risk cardiovascular patients.
Reference
Dennis K et al. PCSK-9-inhibitor therapy improves endothelial function in high-risk patients with cardiovascular disease. Clinical Research in Cardiology. 2024:1-12.
