PCSK-9 inhibitors: a new direction for the future treatment of ischemic stroke

Zhou, Lin; Zhang, Hongyu; Wang, Shuyi; Zhao, Hong; Li, Yongnan; Han, Juqian; Zhang, Hongxu; Li, Xiaoyuan; Qu, Zhengyi

doi:10.3389/fphar.2023.1327185

Cited by 2 publications

(1 citation statement)

References 71 publications

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“…For example, Ya-Wen Lu et al performed a single-center retrospective study, recruiting 409 patients with acute myocardial infarction, to explore the relationships between baseline LDL-C concentrations and clinical outcomes according to different nutritional status, and the results showed that lipid paradox was only observed among patients at high-risk of malnutrition 42 . All those results hints that although current clinical practice concentrates on the lipid-lowering therapy and effective control of serum lipids as a crucial approach to preventing or treating ischemic stroke 43,44 , when treating patients with malnutrition, the improvement of nutritional status may be more beneficial than strict lipid management.…”

Section: Discussionmentioning

confidence: 99%

Elevated remnant cholesterol improves prognosis of patients with ischemic stroke and malnutrition: a cohort-based study

Niu,

Wang,

Yang

et al. 2024

Preprint

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BackgroundAggressive lipid-lowering therapy is recommended for patients with ischemic stroke; however, lipid paradox has been reported in several clinical studies. The mechanism of lipid paradox remains uncertain, and nutrition maybe one explanation. In this prospective cohort study, we explored the associations between baseline remnant cholesterol (RC) concentrations and clinical outcomes in patients with ischemic stroke, stratified by nutritional status.Materials and MethodsA total of 5257 patients with ischemic stroke were recruited for analysis. The Controlling Nutritional Status (CONUT) score was utilized to investigate the risk of malnutrition. Individuals were classified into 4 groups based on their CONUT score. Poor outcomes and all-cause mortality were compared among patients with varied nutritional status and RC levels.ResultsPatients with moderate-severe malnutrition had the highest incidences of in-hospital complications, including pulmonary infection, renal dysfunction, and hemorrhagic transformation, and the highest rates of poor outcomes (61.3%,P<0.001) and all-cause mortality (32.8%,P< 0.001) during the 3-month follow-up period. Baseline higher RC level was an independent protective factor of adverse clinical outcomes for patients with any degree of malnutrition, which was not observed in patients without malnutrition. In addition, compared with the moderate-severe malnourished with RC <0.471 mmol/L, the adjusted ORs for poor outcomes and all-cause mortality were 0.805 (0.450–1.438) and 0.898 (0.502-1.607) for participants with 0.471-0.632 mmol/L, 0.259 (0.095-0.704) and 0.222 (0.061-0.810) for 0.633-0.868 mmol/L, and 0.160 (0.037–0.689) and 0.202 (0.042-0.967) for ≥ 0.869 mmol/L, prospectively.ConclusionLipid paradox was only observed in the malnourished patients with ischemic stroke. Strict lipid reduction therapy is still recommended for patients with ischemic stroke and good nutritional status. However, when treating patients at any risk of malnutrition, the improvement of nutritional status may be more crucial than aggressive lipid control.

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Section: Discussionmentioning

confidence: 99%

Elevated remnant cholesterol improves prognosis of patients with ischemic stroke and malnutrition: a cohort-based study

Niu,

Wang,

Yang

et al. 2024

Preprint

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PCSK9 inhibitor in acute ischemic stroke patient receiving mechanical thrombectomy: early outcomes and safety

Kim,

Hong,

Yoon

et al. 2024

Front. Neurol.

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BackgroundLipid-lowering therapies are mainstays in reducing recurrence after acute ischemic stroke (AIS). Evolocumab, a Proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitor, is a promising lipid-lowering agent known to decrease LDL cholesterol and mitigate vascular events alongside statins. However, its effects on the early functional outcomes post-mechanical thrombectomy (MT) remain unclear. This study aimed to assess the short-term effects and incidence of bleeding events after the early, off-label use of PCSK9 inhibitors in AIS patients undergoing MT.MethodsWe retrospectively analyzed patients who had MT at a Regional Stroke Center from December 2018 to April 2023. Our primary outcome was discharge functional outcomes. Secondary outcomes included early neurologic deterioration (END), symptomatic intracerebral hemorrhage (sICH), 3-month functional outcomes, 3-month recurrence rate, and lipid profiles.ResultsOf 261 patients (mean age 69.2 ± 11.7, men 42.9%), 42 were administered evolocumab peri-procedurally. While baseline characteristics were similar between the two groups, evolocumab group demonstrated improved discharge outcomes, with a lower mean NIHSS (8.8 ± 6.8 vs. 12.4 ± 9.8, p = 0.02) and a higher percentage of patients with discharge mRS ≤ 3 (52.4% vs. 35.6%, p = 0.041). The 3-month follow-up show a non-significant trend toward an improved outcome in the evolocumab group. Multivariable analysis indicated that evolocumab had a potential impact on favorable discharge outcomes (aOR 1.98[0.94–4.22] for mRS ≤ 3 and 0.47[0.27–0.84] for lower ordinal mRS). Notably, evolocuamb users exhibited fewer instances of END and sICH, although they do not reach statistical significance. Additionally, the evolocumab group demonstrated potential benefits in LDL cholesterol reduction over time.ConclusionEarly use of evolocumab in AIS patients undergoing MT appeared to be safe and associated with better early functional outcomes. The potential benefit of the PCSK9 inhibitor shown here warrants further prospective studies.

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PCSK-9 inhibitors: a new direction for the future treatment of ischemic stroke

Cited by 2 publications

References 71 publications

Elevated remnant cholesterol improves prognosis of patients with ischemic stroke and malnutrition: a cohort-based study

Elevated remnant cholesterol improves prognosis of patients with ischemic stroke and malnutrition: a cohort-based study

PCSK9 inhibitor in acute ischemic stroke patient receiving mechanical thrombectomy: early outcomes and safety

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