Evolocumab attenuate pericoronary adipose tissue density via reduction of lipoprotein(a) in type 2 diabetes mellitus: a serial follow-up CCTA study
Authors' conclusion
In patients with T2DM, evolocumab is an effective therapy to decrease noncalcified plaque volume necrotic volume, and increase calcified plaque volume. Furthermore, evolocumab could attenuate PCAT density, at least in part, via the reduction of lipoprotein(a).
Study context
- Population
- Consecutive T2DM patients with stable chest pain and low-density lipoprotein cholesterol (LDL-C) ≥ 70 mg/dL on maximally tolerated statin, January 2020 to December 2022; mean age 64 ± 10.6 years, 131 men
- Participants
- 170 patients
- Exposure
- Evolocumab plus statin vs statin alone
- Evolocumabn = 85
- Controln = 85reference
- Outcome
- PCAT density (coronary inflammation) on CCTA
- Follow-up
- 48-week
Methodological detailsserial CCTA, serial follow-up CCTA
- Serial CCTA
- Serial follow-up CCTA
Main finding
As reported in the abstract
PCAT density of right coronary artery · 48-week follow-up
- Pericoronary adipose tissue (PCAT) density of RCA significantly attenuated in evolocumab group
- p < 0.001
Observational data: associations, not effects.
Further findings
LDL-C · follow-up
- LDL-C reduced after evolocumab treatment
- P < 0.001
Lipoprotein(a) · follow-up
- Lp(a) reduced after evolocumab treatment
- P = 0.002
Obstructive lesions and high-risk plaque features
- Prevalence significantly decreased
- P < 0.05 for all
Plaque volumes
- Calcified plaque volume significantly increased
- P = 0.015
- Noncalcified plaque volume diminished
- P = 0.038
- Necrotic volume diminished
- P < 0.001
Correlations with achieved LDL-C and Lp(a)
- Change in calcified plaque volume vs achieved LDL-C
- r = - 0.31, p < 0.001
- Change in calcified plaque volume vs achieved Lp(a)
- r = - 0.33, p < 0.001
- Changes in noncalcified and necrotic volume positively correlated with achieved LDL-C and Lp(a)
- P < 0.001 for all
- Change in PCAT RCA density correlated only with achieved Lp(a)
- r = 0.51, p < 0.001
Causal mediation by Lp(a) of evolocumab effect on PCAT RCA change
- Proportion mediated by Lp(a)
- 69.8% (p < 0.001)
Original publication
Evolocumab attenuate pericoronary adipose tissue density via reduction of lipoprotein(a) in type 2 diabetes mellitus: a serial follow-up CCTA study. Cardiovasc Diabetol. Published 22 May 2023. doi:10.
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