Effect of Evolocumab on Vulnerable Coronary Plaques: A Serial Coronary Computed Tomography Angiography Study

Abstract

This study investigated the effects of evolocumab on vulnerable coronary plaques and factors associated with the change in stability and size of plaques in patients taking statins. Vulnerable coronary plaques were defined using coronary computed tomography (CT) angiography as having a density of <50 HU within the region of interest and a remodeling index ≥1.1. The changes in minimum CT density, remodeling index, and percent stenosis of vulnerable coronary plaques after six months of evolocumab administration were retrospectively analyzed in 136 vulnerable coronary plaques from 98 patients (68 men and 30 women; mean age: 72.9 ± 8.7 years) treated with a statin. The administration of evolocumab significantly increased the minimum CT density (39.1 ± 8.1 HU to 84.9 ± 31.4 HU, p < 0.001), reduced the remodeling index (1.29 ± 0.11 to 1.19 ± 0.10, p < 0.001), and decreased the percent stenosis (27.0 ± 10.4% to 21.2 ± 9.8%, p < 0.001). Multiple linear regression analysis revealed that baseline percent stenosis (standard coefficient (β) = −0.391, p = 0.002) independently correlated with the change in minimum CT density, whereas the baseline remodeling index (β = −0.368, p < 0.001) independently correlated with a change in the remodeling index. Evolocumab stabilized vulnerable coronary plaques and reduced their size. These results suggest that evolocumab protects against coronary artery disease progression in patients taking statins.

Atherosclerosis evaluation and cardiovascular risk estimation using coronary computed tomography angiography

“… 82–84 Similar results were found in a study using serial CCTA imaging. 85 Both icosapent ethyl and colchicine have also shown to result in reductions in low-density or non-calcified plaque using serial CCTA ( Table 3 ). 86–89 …”

Clinical Course of Optical Coherence Tomography-Detected Lipid-Rich Coronary Plaque After Optimal Medical Therapy

“…remodeling index and minimum CT value improved in patients whose LDL-C was controlled around 19 mg/dL after 6 months of lipid-lowering therapy; these findings were not observed in patients whose LDL-C was controlled to 69 mg/dL. 30 Therefore, to reduce lipid volume in patients with large LRCP, the target LDL-C must be as low as possible. Patients with a larger lipid arc at the non-culprit lesion on baseline OCT, especially an arc >154°, must be treated with aggressive lipid-lowering therapy.…”

Longitudinal Assessment of Coronary Plaque Regression Related to Sodium-Glucose Cotransporter-2 Inhibitor Using Coronary Computed Tomography Angiography

“…Therefore, stabilizing and regressing atherosclerotic plaque are primary objectives in ASCVD management. Previous trials have shown promising results in delaying plaque development using statins, evolocumab, low-dose colchicine, and icosapent ethyl [22][23][24][25]. However, the effect of SGLT2i [27,28].…”