Evolocumab in Combination with Statins for CVD Risk Reduction: An Evidential Review

Abstract

Objectives: The objectives of this evidential review is to conceptualize the ability of Evolocumab in combination with statins for reducing low density lipoprotein concentrations (LDL-C) and its impact on other lipid parameters, ultimately leading to cardiovascular disease risk reduction. Background: For years, atherosclerotic cardiovascular diseases have been one of the leading burdens on healthcare system attributed to high rate of mortalities. The primary treatment approach included the use of statins as the first line of drug. However, despite its side effects, high amount of residual cholesterol that would be left behind and contributes as a risk factor for future cardiovascular events. Methods: The search included PubMed, BioMed Central (BMC), Clinical key, Scopus, ScienceDirect and the Cochrane CENTRAL, using the following search terms and key words: ‘PCSK9 inhibitors’, ‘PCSK9’, ‘AMG 145’ or ‘Evolocumab’ in association with ‘CVD risk reduction’ and ‘statins’. The search was restricted to trials conducted after 2012. Results and Discussion:
Evolocumab showed greater degree of LDL-C reduction as compared with placebo and only statins group, irrespective of statin dose. A pooled estimate of 58.5% reduction in LDL-C reduction is caused by Evolocumab and thereby playing a major role in both treatment and the prevention of further cardiovascular events. Furthermore, Evolocumab when used in combination with statins showed a much higher reduction in LDL-C levels and thereby resulting in an optimised lipid management. Conclusion: It is well evident that Evolocumab in combination with statins is very efficacious in LDL-C reduction and hence atherosclerotic cardiovascular risk reduction. Yet, further studies are required to define the dose of statins to be incorporated in the combination.