New LDL-Lowering Agent Reverses Coronary Artery Disease
Adding the new PCSK9 inhibitor alirocumab (Praluent®) to high-intensity statin therapy after a recent heart attack helped reverse the amount of plaque in arteries throughout the heart and appeared to stabilize the remaining plaque, researchers reported online April 3 in the Journal of the American Medical Association. The PACMAN-AMI trial randomized 300 heart-attack patients undergoing stenting to injections of alirocumab or placebo plus rosuvastatin (Crestor®) 20 mg for 52 weeks starting within 24 hours of their heart attack. At the end of the study, the total amount of arterial plaque (atheroma burden) had regressed twice as much in participants who had received the PCSK9 inhibitor as in those on statin therapy alone (2.1% versus 0.9%). Additionally, the loss of lipid core in soft plaques—the feature that makes them dangerous and prone to rupture, and the increase in fibrous cap thickness, which can help prevent plaque rupture, was double in those taking alirocumab. These beneficial changes were attributed to alirocumab’s ability to push LDL-cholesterol levels to 50 milligrams per deciliter or lower within four weeks. The lower the LDL-C level achieved, the greater the benefit, the researchers found.