Application possibilities of PCSK9 inhibitors in patients with coronary heart disease in combination with type 2 diabetes mellitus

Abstract

Introduction. Coronary heart disease (CHD) combined with type 2 diabetes mellitus (DM) requires enhanced secondary prevention.The aim of the study was to evaluate the application possibilities of PCSK9 inhibitors in patients with coronary heart disease combined with type 2 diabetes.Materials and methods. The study included 77 patients with coronary heart disease divided into 2 groups: the first group without type 2 diabetes (n=39) and the second group with concomitant type 2 diabetes (n=38). Before the experiment started all patients received a combination of the maximum tolerated dose of atorvastatin and ezetimibe and did not reach the target values of low-density lipoprotein cholesterol (LDL cholesterol), after that alirocumab was added to treatment. In all patients, for 12 months, the parameters of the lipid transport system, glycated hemoglobin and the dynamics of changes in the thickness of the intima-media complex of the carotid arteries were evaluated.Results. After starting treatment with alirocumab, in the first group, LDL cholesterol targets reached 97.4 % (n=38), in the second group – 94.7 % (n=36). The LDL cholesterol level in the first group decreased from 2.27 [2.21; 2.35] to 1.15 [1.07; 1.28] mmol/l (by 49.1 %, p<0.001), in the second group from 2.32 [2.27; 2.36] to 1.17 [1.12; 1.19] mmol/l (by 49.6 %, p<0.001). A direct strong statistically significant correlation was revealed between the concentration of LDL cholesterol and other indicators of lipid metabolism.Conclusion. The obtained results of PCSK9 inhibitors appliance in CHD patients with very high cardiovascular risk demonstrate a decrease in LDL cholesterol by 73.9 % in the group of CHD patients and by 74.2 % in the group of CHD patients in combination with type 2 diabetes. In the first group, the target concentrations of LDL cholesterol were reached by 97.4 % of patients, in the second group – 94.7 %. The achieved hypolipidemic effect was simultaneously combined with a decrease in the thickness of the intima-media complex in the group of patients with coronary artery disease: for the right common carotid artery by 7.8 %, for the left by 10.9 %; in patients with coronary heart disease with concomitant type 2 diabetes: for the right common carotid artery by 8.3 %, for the left by 8.1 %.