Dynamics of lipid metabolism parameters following the change of targeted therapy for hypercholesterolemia after acute coronary syndrome

Aim. To evaluate lipid metabolism dynamics by switch from inclisiran to alirocumab in the setting of lipid-lowering therapy (LLT) after acute coronary syndrome (ACS). Materials and methods. 26 patients survived ACS with low-density lipoprotein cholesterol (LDL-C) ≥ 4.0 mmol/L during hospitalization were included. All patients were prescribed inclisiran within 6 months after ACS. Each patient received it at least twice. All patients were expected to undergo an unplanned switch from inclisiran to alirocumab due to logistical reasons. All patients gave consent to participate in the study. Eight visits were conducted to assess LDL-C levels: 3 and 1 month before the end of inclisiran therapy, on the day of the first alirocumab injection and 1, 2, 3, 4, and 5 months after the start of alirocumab therapy. Results. LDL-C values (Me [Q1; Q3]) during the inclisiran treatment period (visits 1–3) were 1.34 [0.55; 1.41], 1.44 [0.53; 2.00], 1.67 [1.08; 1.96] mmol/l and during alirocumab treatment (visits 4–8) – 1.10 [0.61; 1.55], 0.95 [0.69; 1.40], 1.01 [0.86; 1.55], 0.88 [0.71; 1.53], 0.87 [0.70; 1.22] mmol/l (p = 0.002). The first administration of alirocumab at visit 3 was associated with the greatest reduction in LDL-C over the month (-34.1%; p = 0.001). Conclusion. The switch from inclisiran to alirocumab in post-ACS patients resulted in a rapid LDL-C reduction without any adverse events.