Background: Proprotein Convertase Subtilisin/Kexin type 9 (PCSK9) inhibitor antibodies reduce the frequency of new cardiovascular (CV) events through Low-Density Lipoprotein Cholesterol (LDL-C) reduction and plaque stabilisation. However, only a few studies have evaluated whether this effect is also determined by an improvement in arterial functional and structural parameters. We aimed to evaluate aortic stiffness (carotid-femoral Pulse Wave Velocity – PWV), arterial structure (carotid Intima-Media Thickness – IMT), and endothelial function (brachial Flow Mediated Dilatation – FMD) in patients treated with Alirocumab and Evolocumab. Methods: This is a monocentric, prospective, longitudinal study on patients who received antibody-based PCSK9-i therapy at the cardiac rehabilitation and CV prevention outpatient clinic of our hospital. All patients starting a PCSK9-i on a clinical basis were enrolled and underwent PWV, FMD, and IMT measurement at three timepoints: the same day of the first injection (T0), after 6 months (T1), and after 12 months (T2). Results: 84 patients concluded the 12-months period. The population's mean age was 67±8.2 years, and most of them were male (70.2%). LDL-C had a significant reduction during the follow-up (117.6±35.6 vs 37.5±26.2 mg/dL, p<0.001). However, there were no significant changes in PWV (10.6±2.8 vs 10.6±2.3 m/s, p=0.124 ), FMD (7.0±8.6 vs 8.3±10.8%, p=0.474 ) and IMT (719.2±184.9 vs 740.9±170.2 μm, p=0.386) values. Conclusions: In our population, PCSK9 inhibitors showed neither significant benefits nor changes in vascular properties; however, the stability of these parameters may indicate a deceleration in the progression of atherosclerotic disease, which might otherwise have worsened in this high-risk population.
Associazione Nazionale Medici Cardiologi Ospedalieri
