A 63 year old male presented to cardiology clinic for follow up evaluation

A 63 year old male presented to cardiology clinic for follow up evaluation. He is diabetic, hypertensive and had AWMI 3 years ago with successful revascularization to LAD. He is taking his medications regularly and has active lifestyle. He never smoked but has positive family history of premature CAD. His examination is unremarkable. His lipid profile showed total cholesterol 331, TG 229, LDL 202, HDL 38. His medication include atorvastatin 40 mg at night, Loprin 150 mg daily,  Ramipril 2.5mg OD, metoprolol 25mg BD, and Insulin lantus 20mg HS. He is worried about his lipid profile and have some queries regarding his optimal treatment.

a)      How will you manage his elevated LDL in view of recent evidence?

b)      What is the route of administration and mechanism of action?

c)      Name the trial which have studied this drug

d)      What was the result 

Answers:

a)      Evolocumab/ Alirocumab/ PCSK9 Inhibitor

b)      Route of administration: Subcutaneous

Mechanism of action: LDL-R in hepatocytes binds to LDL particles and remove them from circulation and returns to cell surface again. PCK9 function as binding protein , binds to LDL – R and promotes their degradation. By blocking PCSK9, these drugs increases availability of LDL-R to remove LDL-C from circulation.

c)      Fourier Trial

d)      Among patient with elevated LV risk on statin therapy, evolucumab appeared to be effective in reducing adverse CV events and was associated with marked reduction in LDL- C level with similar adverse event as compared to placebo

Reference:

Sabatine MS, et al. "Evolocumab and clinical outcomes in patients with cardiovascular disease". The New England Journal of Medicine. 2017. epub 2017-03-17:1-10.[PubMed]