Physicians' Academy for Cardiovascular Education

PCSK9i initiated within 24 hours of ACS presentation rapidly lowers LDL-c

Effect of Evolocumab on Atherogenic Lipoproteins During the Peri- and Early Postinfarction Period: A Placebo-Controlled, Randomized Trial

Literature - Leucker TM, Blaha MJ, Jones SR et al., - Circulation. 2020 Jul 28;142(4):419-421. doi: 10.1161/CIRCULATIONAHA.120.046320.

Introduction and methods

Elevated LDL-c in an early post-acute coronary syndrome (ACS) period is associated with an increased risk of adverse ischemic outcomes [1]. However, achievement of AHA/ACC and ESC recommendations for secondary prevention in high-risk patients with high-dose statins are often not reached until 4 weeks after initiation [2]. This study investigated whether PCSK9 inhibition offers more rapid LDL-c lowering during the peri- and early post-ACS period.

A total of 57 patients with type 1 non-STEMI and troponin I ≥5 ng/mL were randomized to receive either a single dose of evolocumab SQ 420 mg (n=30) or matching placebo (n=27) within 24 hours of presentation. All patients were on high-intensity statins (unless contraindicated) and were treated in accordance with ACS guidelines. Mean age was 55 (SD:13) years, 26% were African American, 42% were women and 60% were on previous statin therapy. The current publication presented outcomes on lipid levels during hospitalization and at 30-day follow-up.

Main results


The outcomes of this study suggest that more patients reach secondary prevention LDL-c targets during the early post-ACS period with evolocumab plus high-intensity statin therapy compared with placebo plus high-intensity statin therapy. The clinical effects of this early, aggressive lipid lowering approach are uncertain and need to be investigated in a randomized controlled trial.


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Find this article online at Circulation.

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