Acute effect of proprotein convertase subtilisin/kexin type 9 inhibitor on oxidized low-density lipoprotein and lipid profile in patients at cardiovascular risk

Background: Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors are a new class of potent lipid-lowering drugs. Oxidized low-density lipoprotein (ox-LDL) is the key pathogenic factor leading to atherosclerosis. However, its effect on ox-LDL levels has not been clinically reported. For the very high-risk Atherosclerotic cardiovascular disease (ASCVD) patients, guidelines propose stricter blood lipid control targets to reduce the recurrence of cardiovascular events.Methods: The clinical data of 290 very high-risk ASCVD patients diagnosed in the First Affiliated Hospital of Zhengzhou University from May 2022 to October 2022 were collected retrospectively. According to whether evolocumab (a PCSK9 inhibitor) was used after percutaneous coronary intervention (PCI), they were divided into evolocumab group (153 cases) and statin monotherapy group (137 cases). At hospital admission, ox-LDL, total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoproteinAl (apoA1), apolipoprotein B-100 (apoB), lipoprotein (a) (Lp(a)), and high-sensitivity reactive protein (hs-CRP) levels were collected and used as baseline data. The above mentioned indexes were collected from the outpatient chart approximately 2 weeks after discharge. We compared the lipid profiles and inflammatory markers between baseline and two weeks later.Results: After two weeks of treatment, TC, TG, LDL-C, apoB, and ox-LDL in the evolocumab group and statin monotherapy group were significantly lower than those before treatment (p<0.05). The decrease of TC, TG, LDL-C, apoB, and ox-LDL in the evolocumab group was more than in the stain monotherapy group (p<0.05). In the evolocumab group, the LDL-C levels decreased by approximately 64.49%. The oxLDL levels also decreased by 68.09%. The levels of TC and TG decreased 54.49% and 17.60%, respectively. The ApoB levels decreased 51.04%. However, the HDL-C and ApoAl levels were not significantly different, regardless of evolocumab administration. hs-CRP level in each group was higher than the baseline and the difference was statistically significant.Conclusion: PCSK9 inhibitors reduce ox-LDL levels in very high-risk ASCVD patients in a short time.