Effect of PCSK9 inhibitors on pulse wave velocity and monocyte-to-HDL-cholesterol ratio in familial hypercholesterolemia subjects: results from a single-lipid-unit real-life setting

• Published in: Acta diabetologica Vol. 58; no. 7; pp. 949 - 957
• Main Authors: Scicali, Roberto, Di Pino, Antonino, Ferrara, Viviana, Rabuazzo, Agata Maria, Purrello, Francesco, Piro, Salvatore
• Format: Journal Article
• Language: English
• Published: Milan Springer Milan 01.07.2021; Springer Nature B.V
• Subjects: Aged; Anticholesteremic Agents - administration & dosage; Anticholesteremic Agents - adverse effects; Anticholesteremic Agents - pharmacology; Arteriosclerosis; Biochemical analysis; Blood Flow Velocity - drug effects; Cholesterol; Cholesterol, HDL - blood; Cohort Studies; Diabetes; Drug Therapy, Combination; Ezetimibe - administration & dosage; Ezetimibe - adverse effects; Ezetimibe - pharmacology; Female; High density lipoprotein; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage; Hydroxymethylglutaryl-CoA Reductase Inhibitors - adverse effects; Hypercholesterolemia; Hyperlipoproteinemia Type II - blood; Hyperlipoproteinemia Type II - drug therapy; Hyperlipoproteinemia Type II - physiopathology; Inflammation; Internal Medicine; Italy; Leukocyte Count; Leukocytes (neutrophilic); Lipid Metabolism - drug effects; Low density lipoprotein; Lymphocytes; Male; Medicine; Medicine & Public Health; Metabolic Diseases; Middle Aged; Monocytes; Monocytes - drug effects; Monocytes - pathology; Neutrophils; Original; Original Article; PCSK9 Inhibitors; Prospective Studies; Pulse Wave Analysis; Statins; Velocity; Italy; Pulse wave velocity; PCSK9 inhibitors; Innate immunity; Inflammatory profile; Familial hypercholesterolemia; Cardiovascular risk
• DOI: 10.1007/s00592-021-01703-z
• ISSN: 0940-5429; 1432-5233

Aims Subjects with familial hypercholesterolemia (FH) are characterized by an increased amount of low-density lipoprotein cholesterol (LDL-C) that promotes a continuous inflammatory stimulus. Our aim was to evaluate the effect of PCSK9-i on inflammatory biomarkers, neutrophil-to-lymphocyte ratio, monocyte-to-high-density lipoprotein ratio (MHR), and on early atherosclerosis damage analyzed by pulse wave velocity (PWV) in a cohort of FH subjects. Methods In this prospective observational study, we evaluated 56 FH subjects on high-intensity statins plus ezetimibe and with an off-target LDL-C. All subjects were placed on PCSK9-i therapy and obtained biochemical analysis as well as PWV evaluation at baseline and after six months of PCSK9-i therapy. Results After six months of add-on PCSK9-i therapy, only 42.9% of FH subjects attained LDL-C targets. As expected, a significant reduction of LDL-C (− 49.61%, p  < 0.001) was observed after PCSK9-i therapy. Neutrophil count (NC) and MHR were reduced by PCSK9-i (-13.82% and -10.47%, respectively, p value for both < 0.05) and PWV significantly decreased after PCSK9-i therapy (− 20.4%, p  < 0.05). Finally, simple regression analyses showed that ∆ PWV was significantly associated with ∆ LDL-C ( p  < 0.01), ∆ NC and ∆ MHR ( p value for both < 0.05). Conclusions In conclusion, PCSK9-i therapy significantly improved lipid and inflammatory profiles and PWV values in FH subjects; our results support the positive effect of PCSK9-i in clinical practice.