Retrospective study on clinical efficacy of Evolocumab in highrisk ASCVD patients

Main Article Content

Fatima Mohamed Alzaabi https://orcid.org/0000-0002-4677-2351
Semira Abdi Beshir https://orcid.org/0000-0003-4990-4783
Emad Abdel Fattah https://orcid.org/0000-0001-7522-7291
Syed Wasif Gillani https://orcid.org/0000-0003-4327-2068

Keywords

evolocumab, saftey, effectiveness, United Arab Emirates

Abstract

Objective: This study evaluated the effectiveness of Evolocumab by measuring achievement target LDL-C among high-risk ASCVD patients in the UAE. Method: A retrospective observational study included 27 patients with high-risk ASCVD receiving Evolocumab 140 mg/mL SC injection every 2 weeks. The effectiveness of Evolocumab is measured by the mean reduction in LDL-C levels from baseline and achieving target LDL levels according to ECS/EAS guideline during average follow up period. Results: The average (SD) age of the patients is 52 (10) years. Majority of the patients were male (n=22), smokers (40.9%), overweight or obese (78%), had a history of hypertension (59.3%), MI (55.5%) and diabetes (40.7%). The patients were on Evolucomab therapy due to persistently elevated LDL-C (n=25) or statin intolerance (n=2). During the average follow up period of 42 weeks,14 patients (51%) achieved target LDL-C level. During this period, LDL-C and TC levels reduced from 3.51(1.3) mmol/L to 1.9 (1.2) mmol/L and from 4.97 (1.4) mmol/L to 1.62 (1.09) mmol/L, respectively post Evolocumab therapy. Conclusion: The reduction was statistically significant. However, the reduction of TG levels and the increase in HDL level was not significant. Evolocumab reduces LDL-C and TC levels significantly in high-risk ASCVD patients in a tertiary hospital in the UAE population.

Abstract 396 | PDF Downloads 389

References

1. Association AD. Cardiovascular disease and risk management. Diabetes Care. 2016;39(1):S60-S71.
2. Lindh M, Banefelt J, Fox K, et al. Cardiovascular event rates in a high atherosclerotic cardiovascular disease risk population:estimates from Swedish population-based register data. Eur Hear Journal Qual Care Clin Outcomes. 2019;5(3):225-232. https://
doi.org/10.1093/ehjqcco/qcy058
3. Razzak HA, Harbi A, Shelpai W, et al. Prevalence and risk factors of cardiovascular disease in the United Arab Emirates. Hamdan Med J. 2018;11(3):105. https://doi.org/10.2174/1573399818666220421113607
4. Al-Shamsi S, Regmi D, Govender RD. Incidence of cardiovascular disease and its associated risk factors in at-risk men and women in the United Arab Emirates: a 9-year retrospective cohort study. BMC Cardiovasc Disord. 2019;19(1):148. https://doi.
org/10.1186/s12872-019-1131-2 
5. Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/ PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart
Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019;73(24):e285-350. https://doi.org/10.1161/ CIR.0000000000000625
6. Dixon DL, Buckley LF, Trankle CR, et al. Clinical utility of evolocumab in the management of hyperlipidemia: patient selection and follow-up. Drug Des Devel Ther. 2017;11:2121. https://doi.org/10.2147/DDDT.S114091
7. Pećin I, Hartgers ML, Hovingh GK, et al. Prevention of cardiovascular disease in patients with familial hypercholesterolaemia: The role of PCSK9 inhibitors. Eur J Prev Cardiol. 2017;24(13):1383-1401. https://doi.org/10.1177/2047487317717346
8. Gandra SR, Villa G, Fonarow GC, et al. Cost-Effectiveness of LDL-C Lowering With Evolocumab in Patients With High Cardiovascular Risk in the United States. Clin Cardiol. 2016;39(6):313-320. https://doi.org/10.1002/clc.22535
9. Verma DR, Brinton EA. Management of hypercholesterolemia for prevention of atherosclerotic cardiovascular disease: Focus on the potential role of recombinant anti-PCSK9 Monoclonal Antibodies. Reviews in Cardiovascular Medicine. 2014;15(2):86-
101. https://doi.org/10.3909/ricm0741
10. Kees HG, BD, Handrean S, et al. Long-Term Evolocumab in Patients With Familial Hypercholesterolemia. J Am Coll Cardiol. 2020;75(6):565-574. https://doi.org/10.1016/j.jacc.2019.12.020
11. Oyama K, Furtado RHM, Fagundes Jr A, et al. Effect of evolocumab on complex coronary disease requiring revascularization. J Am Coll Cardiol. 2021;77(3):259-267. https://doi.org/10.1016/j.jacc.2020.11.011
12. Mach F, Baigent C, Catapano AL, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk: The Task Force for the management of dyslipidaemias of the European Society of Cardiology
(ESC) and European Atherosclerosis Society (EAS). Eur Heart J. 2019;41(1):111-188. https://doi.org/10.1093/eurheartj/ehz455 
13. Vaccarezza M, Papa V, Milani D, et al. Sex/Gender-Specific Imbalance in CVD: Could Physical Activity Help to Improve Clinical Outcome Targeting CVD Molecular Mechanisms in Women? Int J Mol Sci. 2020;21(4):147. https://doi.org/10.3390/
ijms21041477
14. Razzak HA, Harbi A, Ahli S. Tobacco Smoking Prevalence, Health Risk, and Cessation in the UAE. Oman Med J. 2020;35(4):e16. https://doi.org/10.5001/omj.2020.107
15. Beshir SA, Hussain N, Elnor AA, et al. Umbrella Review on Non-Statin Lipid-Lowering Therapy. J Cardiovasc Pharmacol Ther. 2021;26(5):437-452. https://doi.org/10.1177/10742484211002943
16. Blom DJ, Dent R, Castro RC, et al. PCSK9 inhibition in the management of hyperlipidemia: focus on evolocumab. Vasc Health Risk Manag. 2016;12:185. https://doi.org/10.2147/VHRM.S102564
17. Koren MJ, Sabatine MS, Giugliano RP, et al. Long-Term Efficacy and Safety of Evolocumab in Patients With Hypercholesterolemia. J Am Coll Cardiol. 2019;74(17):2132-2146. https://doi.org/10.1016/j.jacc.2019.08.1024
18. Sabatine MS, Giugliano RP, Keech AC, et al. Evolocumab and Clinical Outcomes in Patients with Cardiovascular Disease. N Engl J Med. 2017;376(18):1713-1722. https://doi.org/10.1056/NEJMoa1615664
19. Alonso R, Isla LP de, Muñiz-Grijalvo O, et al. Familial hypercholesterolaemia diagnosis and management. Eur Cardiol Rev. 2018;13(1):14-20. https://doi.org/10.15420/ecr.2018:10:2
20. Leuzzi C, Sangiorgi GM, Modena MG. Gender‐specific aspects in the clinical presentation of cardiovascular disease. Fundam Clin Pharmacol. 2010;24(6):711-717. https://doi.org/10.1111/j.1472-8206.2010.00873.x
21. Rodgers JL, Jones J, Bolleddu SI, et al. Cardiovascular risks associated with gender and aging. J Cardiovasc Dev Dis. 2019;6(2):19. https://doi.org/10.3390/jcdd6020019
22. Stroes E, Robinson JG, Raal FJ, et al. Consistent LDL-C response with evolocumab among patient subgroups in PROFICIO: A pooled analysis of 3146 patients from phase 3 studies. Clin Cardiol. 2018;41(10):1328-1335. https://doi.org/10.1002/clc.23049
23. Mahmeed WA, Habib M, Villa G, et al. Burden of Cardiovascular Disease (CVD) For Patients With Familial Hypercholesterolemia (FH) Or Atherosclerotic CVD (ASCVD) And The Impact Of Low Density Lipoprotein-Cholesterol (LDL-C) Lowering In Two
Middle East Countries. Value Heal. 2017;20(9):A610. 
24. Murphy SA, Pedersen TR, Gaciong ZA, et al. Effect of the PCSK9 Inhibitor Evolocumab on Total Cardiovascular Events in Patients With Cardiovascular Disease: A Prespecified Analysis From the FOURIER Trial. JAMA Cardiol. 2019;4(7):613-619.
https://doi.org/10.1001/jamacardio.2019.088

Most read articles by the same author(s)