The dynamics of atherogenic
lipoproteins and estrogens during the management of dyslipidemia with PCSK9
inhibitors in patients with various comorbidities
Kuznetsov A. A., Mal G.S.
ABSTRACT
Objective. To assess the dynamics of atherogenic
lipoproteins and estrogens during the management of dyslipidemia with PCSK-9
inhibitors in patients with coronary artery disease (CAD) and various
comorbidities.
Materials and methods. The study included 114 men with CAD and very high cardiovascular
risk. All patients were divided into three groups: group 1 — patients with
CAD (n=39), group 2 — patients with CAD in combination with type 2 diabetes mellitus (T2DM) (n=38), group 3 — patients
with CAD in combination with stages IIIA-IIIB of chronic kidney disease
(CKD) (n=37). All study participants were administered
with intense treatment with statins + ezetimibe. In case when target levels of
low-density lipoprotein cholesterol (LDL–C) were not achieved,
alirocumab was added to treatment with the control of
lipid profile and estrogens levels for 12 months.
Results. In group 1 97.4 % of patients (n=38) achieved target LDL–C level
that decreased by 73.9 % from 4.41±0.19 mmol/l to
1.15±0.15 mmol/l (p<0.001); in group 2 94.7 % of
patients (n=36) achieved target LDL–C level that decreased by 74.2 % from
4.62±0.25 mmol/l to 1.19±0.12 mmol/l
(p<0.001), in group 3 91.9 % of patients reached target values (n=34) and
LDL–C decreased by 73.5 % from 4.60±0.20 mmol/l to
1.22± 0.09 mmol/l (p<0.001). The level of
estradiol after 12 months after treatment with alirocumab
increased by 8.3 % (p=0.39) in group 1, by 7.7 %
(p=0.36) — in group 2, by 8.5 % (p=0.31) — in group 3.
Conclusion. Thus, the use of PCSK9 inhibitors in combination with optimal
lipid-lowering therapy in patients with very high cardiovascular risk showed
clear effectiveness in patients with CAD without comorbidities. In all study
groups, plasma estradiol level statistically insignificantly increased after alirocumab treatment.
Key words: coronary artery disease, dyslipidemia, estrogens, secondary prevention.
For citation:
Kuznetsov A. A., Mal G.
S. The dynamics of atherogenic lipoproteins and
estrogens during the management of dyslipidemia with PCSK9 inhibitors in
patients with various comorbidities. International Heart and Vascular
Disease Journal. 2022;
10(35): 18-26. doi: 10.24412/2311-1623-2022-34-23-32