Author + information
- Sarah Min, MD,
- Naila Goldenberg, MD,
- Charles Glueck, MD and
- Ping Wang, PhD
Reduction of low-density lipoprotein cholesterol (LDLC) to <70 mg/dL is optimal in high-risk patients with cardiovascular disease (CVD). In 107 high-risk, high LDLC patients (70 intolerant to any statin dose-sequence), only 3 (3%) had entry LDLC <70 mg/dL on a maximal tolerated LDLC lowering regimen. In these 107 patients, our specific aim was to assess efficacy of alirocumab (ALI) and evolocumab (EVO) in lowering LDLC to <70 mg/dL.
We followed 107 patients for a median 24 weeks on ALI 75 mg (n=33), ALI 150 mg (n=30), or EVO 140 mg (n=44) every 2 weeks. Of the 107 patients, 43 had heterozygous familial hypercholesterolemia (HeFH), 38 CVD, and 26 both HeFH and CVD.
Median entry LDLC was 149 mg/dL for all patients, 181 for HeFH only, 132 for CVD only, and 161 for both HeFH and CVD. For the full cohort, 73 of 107 patients (68%) achieved LDLC <70 mg/dL on treatment. Of the 43 patients with HeFH only, 51% achieved LDLC <70 mg/dL on ALI or EVO. Of the 38 with CVD only, 87% achieved LDLC <70 mg/dL. In 26 patients with both HeFH and CVD, 69% achieved LDLC <70 mg/dL. Of 33 patients on ALI 75 mg, 24 (73%) achieved LDLC <70 mg/dL. Of 30 patients on ALI 150 mg, 21 (70%) achieved LDLC <70 mg/dL. Of 44 patients on EVO 140 mg, 28 (64%) achieved LDLC <70 mg/dL.
Optimal LDLC reduction to <70 mg/dL was achieved in 73 of 107 (68%) in our cohort with EVO or ALI, demonstrating the central importance of ALI and EVO in high-risk patients who otherwise do not achieve LDLC <70 mg/dL with maximal tolerated LDLC lowering regimens.