Effects of Evolocumab on Carotid Intima-Media Thickness and Clinical Parameters in Patients Taking a Statin

We determined the effects of evolocumab, a fully human monoclonal antibody targeting proprotein convertase subtilisin/kexin type 9, on carotid intima-media thickness (IMT) and the factors associated with the change in carotid IMT in patients taking a statin. The change in carotid mean and maximum IMT before and after the initiation of evolocumab treatment was retrospectively analyzed in 229 statin-treated patients. The changes in clinical parameters, including serum lipid concentrations, were also evaluated. Evolocumab significantly reduced the increase in carotid mean and maximum IMT (0.09 +/- 0.13 mm/year to -0.04 +/- 0.16 mm/year,p< 0.001 and 0.17 +/- 0.38 mm/year to 0.08 +/- 0.47 mm/year,p= 0.02). Evolocumab reduced serum total cholesterol, low-density lipoprotein-cholesterol, triglyceride, and lipoprotein (a) concentrations (eachp< 0.001), and increased serum high-density lipoprotein (HDL)-cholesterol concentrations (p= 0.01). Multiple linear regression analysis revealed that the change in HDL-cholesterol (standard coefficient (beta) = -0.120,p= 0.04) and carotid mean IMT (beta= -0.467,p< 0.001) were independently correlated with the change in carotid mean IMT during the administration of evolocumab, whereas the change in HDL-cholesterol (beta= -0.208,p= 0.002) and log-triglyceride (beta= -0.167,p= 0.01) independently correlated with the change in carotid maximum IMT. Evolocumab reduced the increase in carotid IMT in patients taking a statin. These results suggest that evolocumab is protective against carotid atherosclerosis in patients undergoing statin therapy.