Time to achieve target lipid metabolism parameters and its impact on long-term outcomes after acute coronary syndrome in conditions of multicomponent lipid-lowering therapy

Aim. To evaluate the effect of the initiation time of lipid-lowering therapy (LLT) with the use of the proprotein convertase subtilisin/kexin type 9 (iPCSK9) inhibitor alirocumab on the incidence of adverse outcomes during 18-month follow-up after acute coronary syndrome (ACS). Materials and methods. Two groups of patients were observed. In both groups iPCSK9 alirocumab was prescribed within a year after ACS as part of multicomponent LLT: Group 1 (n=20) – alirocumab therapy was started 3 or more months after ACS, Group 2 (n=18) – alirocumab was started up to 3 months after ACS. Control visits were performed at 3, 6, 12 and 18 months after ACS to assess the character of LLT, long-term outcomes and dynamics of low-density lipoprotein cholesterol. Results. In groups 1 and 2, the proportions of those who achieved the target low-density lipoprotein cholesterol after 6 and 12 months, respectively, were 40.0 and 83.3% (p=0.008), 55.0 and 88.9% (p=0.024). A more than three-fold decrease in the need for rehospitalizations for any and cardiovascular reasons was noted among patients with an earlier start of PCSK9-targeted therapy. The need for cardiovascular hospitalizations directly correlated with the period (number of months) before alirocumab was prescribed (R=0.44; p=0.006). Conclusion. The use of alirocumab as a part of outpatient low-density lipoprotein cholesterol LLT provides a powerful corrective effect on the lipid profile, as well as an improvement in long-term outcomes after ACS. The positive results of this therapy are especially noticeable when it is started within 3 months after the cardiovascular event.