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Kidney Week

Abstract: TH-OR100

Effect of Evolocumab, an Anti-PCSK9 Antibody, on Vulnerable Coronary Plaque in CKD Patients Taking Statins

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Hirai, Keiji, Saitama Medical Center, Jichi Medical University, Saitama, Japan
  • Imamura, Shigeki, Chiba cerebral and cardiovascular center, Chiba, Japan
  • Hirai, Aizan, Chiba cerebral and cardiovascular center, Chiba, Japan
  • Ookawara, Susumu, Saitama Medical Center, Jichi Medical University, Saitama, Japan
  • Morishita, Yoshiyuki, Saitama Medical Center, Jichi Medical University, Saitama, Japan
Background

Coronary artery disease is a crucial complication in patients with chronic kidney disease (CKD). This study investigated the effects of evolocumab, a fully human monoclonal antibody against proprotein convertase subtilisin kexin type 9 (PCSK9), on vulnerable coronary plaques in CKD patients taking statins.

Methods

Vulnerable coronary plaques were defined by coronary computed tomography (CT) as having a density of <60 HU within the region of interest and remodeling index >1.1. Fifty-two CKD patients who had a vulnerable coronary plaque and who were taking stains (35 males, 17 females; mean age, 75.8 ± 7.0 years; mean estimated glomerular filtration rate, 51.4 ± 6.1 mL/min/1.73 m2) were administrated evolocumab (140mg every two weeks) for 6 months. The change in 155 vulnerable coronary plaques from 52 CKD patients was evaluated before and after evolocumab administration. The changes in lipid metabolism were also evaluated.

Results

Evolocumab significantly increased the CT density (from 50.5 ± 9.9 HU to 102.4 ± 32.5 HU, p < 0.001) and reduced the remodeling index (from 1.28 ± 0.10 to 1.19 ± 0.09, p < 0.001) in vulnerable coronary plaques in CKD patients. Evolocumab also decreased low-density lipoprotein cholesterol (from 65.6 ± 22.2 mg/dL to 18.1± 11.8 mg/dL, p < 0.001), triglyceride (from 156.5 ± 172.3 mg/dL to 98.1 ± 61.4 mg/dL, p < 0.01), and lipoprotein (a) (from 23.9 ± 25.9 mg/dL to 14.5 ± 19.5 mg/dL, p < 0.001), and increased high-density lipoprotein cholesterol (from 52.5 ± 12.7 mg/dL to 57.8 ± 12.4 mg/dL, p < 0.001).

Conclusion

Evolocumab stabilized and reduced coronary vulnerable plaques and improved lipid metabolism in CKD patients taking stains. These results suggest that evolocumab has protective effects against coronary artery disease progression in CKD patients taking statins.