Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

LDL-C Reduction & Arterial Wall Inflammation

Eur Heart J; ePub 2018 Dec 18; Stiekema, et al

In patients with median baseline lipoprotein(a) [Lp(a)] 200.0 nmol/L, evolocumab treatment led to a large reduction in low-density lipoprotein cholesterol (LDL-C) and a small reduction in Lp(a), resulting in persistent elevated Lp(a) levels. In this multicenter, randomized, double-blind, placebo-controlled study, researchers evaluated whether evolocumab attenuates arterial wall inflammation in patients with elevated Lp(a). They found:

  • 129 patients (median age 60 years, Lp(a) 200.0 nmol/L, man LDL-C 3.7 mmol/L) were randomized to monthly subcutaneous evolocumab 420 mg or placebo.
  • Compared with placebo, evolocumab reduced LDL-C by 60.7% and Lp(a) by 13.9%.
  • Among evolocumab-treated patients, the Week 16 mean LDL-C level was 1.6 mmol/L and the median Lp(a) level was 188.0 nmol/L.
  • Week 16 index vessel most diseased segment target-to-background ratio (MDS-TBR) was not significantly altered with evolocumab (‒8.3%) vs placebo (‒5.3%).


Stiekema LCA, Stroes ESG, Verweij, et al. Persistent arterial wall inflammation in patients with elevated lipoprotein(a) despite strong low-density lipoprotein cholesterol reduction by proportion convertase subtilisin/kexin type 9 antibody treatment. [Published online ahead of print December 18, 2018]. Eur Heart J. doi:10.1093/eurheartj/ehy862.