Alirocumab benefits CAD patients only if lipoprotein (a) levels elevated: Study

The researchers conducted the ODYSSEY Outcomes, wherein they compared alirocumab with placebo in 18,924 patients with recent acute coronary syndromes receiving optimized statin treatment. In 4,351 patients (23.0%), screening or randomization LDL-C was <70 mg/dL; in 14,573 patients (77.0%), both determinations were ≥70 mg/dL.

The results of the study are as follows:

• In the lower LDL-C subgroup, MACE rates were 4.2 and 3.1 per 100 patient-years among placebo-treated patients with baseline lipoprotein(a) greater than or less than or equal to the median (13.7 mg/dL).
• Corresponding adjusted treatment hazard ratios were 0.68, with treatment-lipoprotein(a) interaction on MACE (Pinteraction = 0.017).
• In the higher LDL-C subgroup, MACE rates were 4.7 and 3.8 per 100 patient-years among placebo-treated patients with lipoprotein(a) >13.7 mg/dL or ≤13.7 mg/dL; corresponding adjusted treatment hazard ratios were 0.82 and 0.89, with Pinteraction = 0.43.

The researchers concluded that in patients with recent acute coronary syndromes and LDL-C near 70 mg/dL on optimized statin therapy, proprotein subtilisin/kexin type 9 inhibition provides incremental clinical benefit only when lipoprotein(a) concentration is at least mildly elevated.

Reference:

Lipoprotein(a) and Benefit of PCSK9 Inhibition in Patients With Nominally Controlled LDL Cholesterol by Schwartz G et. al published in the J Am Coll Cardiol.

https://www.jacc.org/doi/abs/10.1016/j.jacc.2021.04.102