Drug combo reverses coronary plaques to lowest levels yet


World-first results: Researchers have found a drug combination that reduces coronary atherosclerosis more effectively than statins alone

In an Australian-led multicenter, double-blind, placebo-controlled, randomised clinical trial, researchers have discovered that a cholesterol-lowering PCSK9 inhibitor called evolocumab could be key in reducing coronary plaque build-up.

The GLAGOV trial was conducted at 197 academic and community hospitals across North America, Europe, South America, Asia, Australia, and South Africa and enrolled 968 patients presenting for coronary angiography.

Researchers randomly assigned participants to take either a statin alone, or a statin together with a monthly self-injection of evolocumab, over 76 weeks.

High-risk patients receiving a combination of evolocumab and a statin achieved an average level of low-density lipoprotein (LDL) of just 36.6 mg/dL – the lowest level ever achieved in a major trial of cholesterol-lowering drugs.

The statins-only achieved an average LDL level, while those who received combination therapy reduced their LDL by an additional 60%.

Trial director Professor Stephen Nicholls, a cardiologist at the Royal Adelaide Hospital, says this study has shown cholesterol can be lowered to levels that hadn’t been previously achieved.

“Although statins are currently the best way to lower cholesterol, or LDL, we are looking to see if we can do even better. We desperately need additional therapies to treat our patients with heart disease; this finding brings us one step closer to having another shot on goal.

These findings suggest trials currently underway are likely to show major benefits from combination therapy using a PCSK9 inhibitor and a statin compared with a statin alone, says Professor Nicholls.

“However, it is important to keep mind that this combination therapy may not be for everybody, and in this study we only looked at high-risk heart patients.”

Journal of the American Medical Association, online 15 November 2016

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