Effect of anti-pcsk9 antibodies on artery structure and function: the niguarda hospital cohort

Objective: PCSK9 inhibitors antibodies (PCSK9-i) are a valid option to reduce LDL cholesterol in patients who failed to reach therapeutic target with maximized lipid-lowering therapies or in patient with statins intolerances. These antibodies reduce the frequency of new cardiovascular events, however if this effect is due only to LDL reduction or also to an improvement in arterial function and structure is yet to be proved. Our study aim was to evaluate aortic stiffness (Pulse Wave Velocity - PWV), carotid's Intima-Media Thickness (IMT) and endothelial function (brachial Flow Mediated Dilatation - FMD) in patients treated with Alirocumab and Evolocumab. Design and method: This is a monocentric prospective longitudinal study on patients who received PCSK9-i administrations at the Niguarda Hospital's cardiovascular rehabilitation and prevention unit. They underwent 3 evaluations of PWV, FMD and IMT (T0 the same day of the first injection, T1 after 6 months and T2 after 12 months of therapy). Results: 39 patients concluded the 12 months period. The group average age is 66.8 ± 7.6 years, most of them were male (64.1%). LDL cholesterol average levels were significantly reduced by the therapy (128.3 ± 27.7 vs 44.7 ± 29.3 mg/dL, p<0.001), however, there were no significant changes in PWV (10.2 ± 3.0 vs 10.6 ± 2.5 m/s, p=0.404), FMD (8.6 ± 7.0 vs 8.9 ± 7.4%, p=0.560) and IMT (768.7 ± 175.4 vs 733.5 ± 147.2 μm, p=0.270) values. Conclusions: It was not possible to prove a significant effect of PCSK9-i on vascular properties, however, the stability of these indexes may suggest a deceleration of the atherosclerotic disease which it could have worsen in this population, especially considering the risk factors of our patients.