Efficacy comparison of combined lipid-lowering therapy in patients with acute and chronic coronary artery disease in combination with severe dyslipidemia
Authors:   Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Barbarash O.L. , Sedykh D.Yu. ,   Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Khryachkova O.N. ,   Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Alkhimova T.S. ,   Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Kashtalap V.V. ,   Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo
Published: January 2025

to assess the efficacy and safety of a combined lipid-lowering regimen incorporating a PCSK9 inhibitor (alirocumab) over a four-month
period in patients with acute coronary syndrome (ACS) as well as those with chronic coronary artery disease (CAD), both cohorts also
exhibiting severe dyslipidemia.
Patients and Methods: this single-center, prospective, open-label study involved active treatment of patients with acute (n=5) and chronic
(n=5) CAD. Key inclusion criteria required patients to display significant dyslipidemia, defined by baseline low-density lipoprotein cholesterol
(LDL-C) levels exceeding 3.5 mmol/L. Patients were monitored for four months, receiving monthly subcutaneous injections of alirocumab at a dosage of 300 mg/ml alongside routine lipid profile evaluations. Continuously administered treatments for all patients included atorvastatin
40–80 mg/day or rosuvastatin 20–40 mg/day, with three chronic CAD patients additionally receiving ezetimibe 10 mg/day.
Results: initially, patients with ACS exhibited more pronounced dyslipidemia, with higher median LDL-C levels (p=0.037) and a non-significant
trend toward elevated median total cholesterol (TC) levels (p=0.060). After four months, patients with chronic CAD showed higher median
high-density lipoprotein cholesterol (HDL-C) levels (p=0.037). Both patient groups experienced a significant reduction in median LDL-C levels
following four months of combination therapy with the PCSK9 inhibitor (p<0.001 in ACS, p=0.035 in chronic CAD). Notably, median TC levels
were significantly reduced in the ACS cohort (p<0.001). A lower proportion of patients reached target LDL-C levels in both groups; however,
the percentage decrease in LDL-C was more substantial in patients with ACS (p=0.022). In chronic CAD patients, the LDL-C reduction of 50%
or more from baseline was achieved in 80% of cases (p=0.009). The proportion of patients reaching target triglyceride and HDL-C levels
during treatment was statistically similar across both cohorts. The intensified lipid-lowering strategy using the PCSK9 inhibitor over four
months was well tolerated, with no significant adverse clinical or laboratory safety events observed in either group.
Conclusion: implementing a PCSK9 inhibitor within a combined lipid-lowering treatment strategy proves to be safe in managing both acute
and chronic forms of CAD.
Keywords: dyslipidemia, chronic coronary artery disease, acute coronary syndrome, statins, combination therapy, PCSK9 inhibitors,
alirocumab.
For citation: Barbarash O.L., Sedykh D.Yu., Khryachkova O.N., Alkhimova T.S., Kashtalap V.V. Efficacy comparison of combined lipid-lowering
therapy in patients with acute and chronic coronary artery disease in combination with severe dyslipidemia. RMJ. 2024;9:15–19. DOI: 10.32364/2225-2282-2024-9-3