Efficacy Of PCSK9 Inhibitor Combined With Statins In The Treatment Of ASCVD Super-high Risk Population

ObjectiveTo observe the lipid-lowering effect of statins combined with PCSK9 inhibitor（pretoprotein converting enzyme subtilisin 9 inhibitor）on ultra-high risk ASCVD patients and whether the influence on IMT and cardiovascular and cerebrovascular events（Recurrent myocardial infarction,sudden death,ischemic cerebrovascular disease,etc）is better than that of statins alone.Methods102 patients with ultra-high risk of ASCVD who met the inclusion criteria in Shenyang No.4 People’s Hospital from August 2020 to August 2021 were selected（23patients who had fallen off during the follow-up were excluded）,and they were divided into control group（48 cases）and experimental group（54 cases）according to their treatment willingness.Both groups were treated with ASCVD standard drugs.Control group: Rosuvastatin,10mg/ once a day,was taken orally.Experimental group:Rosuvastatin was treated with drugs,the dose was 10mg/ once a day,and it was taken orally.Eloizumab,a PCSK9 inhibitor,was injected subcutaneously 140mg/ once a week.Both groups were treated continuously and followed up for 6 months.The levels of total cholesterol（TC）,triglyceride（TG）,low-density lipoprotein cholesterol（LDL-C）,high-density lipoprotein cholesterol（HDL-C）and lipoprotein a（LP（a））were observed before treatment,1 month,3 months and 6 months after treatment.Carotid artery ultrasound was examined at baseline and 6 months after treatment,and the changes of carotid intima-media thickness（IMT）were compared（carotid artery ultrasound should be operated by an ultrasound doctor with more than 5 years of working experience）,and the incidence of cardiovascular and cerebrovascular events after 6 months of treatment.ResultsIn this study,125 patients with ultra-high risk of ASCVD were included,and 23 patients with exfoliation were excluded,totaling 102,with an average age of55.78±5.82 years.There were 48 cases in the control group and 54 cases in the experimental group.1.There was no significant difference in sex,age,smoking history and basic medical history between the experimental group and the control group（P > 0.05）.and the two groups are comparable.After 1 month,3 months and 6 months of treatment,the blood lipids were lower than those at the time of admission.2.After 1 month,3 months and 6 months of treatment,the decrease levels of total cholesterol（TC）,low density lipoprotein cholesterol（LDL-C）and lipoprotein a（Lp（a））in the experimental group were better than those in the control group（P < 0.05）.At 1month,3 months and 6 months after treatment,the levels of high density lipoprotein cholesterol（HDL-C）and triglyceride（TG）in the experimental group were no different from those in the control group.（P > 0.05）。3.After 6 months of treatment,the blood lipid compliance rate of the experimental group was significantly better than that of the control group.（P < 0.05）.4.After 6 months of treatment,IMT（carotid intima-media thickness）in the experimental group was lower than that in the control group（P < 0.05）.5.The incidence of cardiovascular and cerebrovascular events in the experimental group was slightly lower than that in the control group within 6 months after treatment（P > 0.05）.There was no significant difference in adverse drug reactions between the two groups within 6 months after treatment.（P > 0.05）。ConclusionsCompared with statins alone,the lipid-lowering effect and the influence on IMT（carotid intima-media thickness）and cardiovascular and cerebrovascular events of PCSK9 inhibitor combined with statins are obviously better than those of statins alone,which has great curative effect on reducing the risk of disease recurrence in patients with ASCVD in the later stage.