Cholesterol-Lowering Drug Evolocumab Shows Promise in Heart Attack Prevention

A recent investigation at Cedars-Sinai Medical Center has shed light on the mechanisms through which the cholesterol-lowering medication evolocumab may help avert heart attacks, particularly in patients suffering from coronary artery disease, which is among the leading causes of mortality in the United States.

Coronary artery disease develops when cholesterol accumulates in the arteries that supply blood to the heart, leading to plaque formation. These plaques, beginning as inflammatory lesions, can grow large and become unstable, increasing the risk of rupture and subsequent heart attacks. Evolocumab belongs to a class of medications known as PCSK9 inhibitors, which have shown significant effectiveness in lowering cholesterol levels.

According to the study's principal investigator, the findings could greatly enhance our understanding of how evolocumab contributes to better cardiovascular health. Researchers administered the drug to a cohort of 47 patients, each presenting notable amounts of noncalcified plaque in their coronary vessels. Noncalcified plaques are particularly concerning as they are softer and more prone to rupture compared to their calcified counterparts.

The research team utilized advanced imaging techniques, including positron emission tomography (PET) and coronary computed tomography angiography (CCTA), in conjunction with a new artificial intelligence-based quantitative method developed at Cedars-Sinai. These tools enabled the assessment of inflammation levels within the coronary arteries before treatment and again after an 18-month period of receiving evolocumab.

The results indicated a significant decrease in plaque inflammation and a reduction in the size of noncalcified plaques following treatment with evolocumab. Researchers noted that while the cholesterol-lowering properties of PCSK9 inhibitors have garnered much attention, their ability to reduce inflammation may play a crucial role in diminishing the likelihood of heart attacks.

These findings are pivotal as they highlight a dual action of evolocumab: not only does it lower cholesterol, but it also mitigates the inflammatory processes that can lead to heart attacks. This could lead to a paradigm shift in how cardiovascular risk is managed in patients with coronary artery disease.

For more detailed information, refer to the study published in the journal JACC: Cardiovascular Imaging, which elaborates on the effects of evolocumab on coronary plaque composition and microcalcification activity.