Regression of carotid atherosclerosis in high‐risk individuals with proprotein convertase subtilisin/kexin type 9 inhibitors

Abstract Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors represent a novel approach for reducing cholesterol and, accordingly, the burden of atherosclerosis. However, limited data are available regarding the possible effects of PCSK9 inhibitors on atherosclerotic plaque. To evaluate the efficacy of PCSK9 inhibitors in reducing carotid plaque progression in individuals with high‐risk carotid atherosclerotic disease. We used carotid total plaque area (TPA) to assess the burden of atherosclerosis. Ultrasound imaging of the carotid was acquired before and after the initiation of PCSK9 inhibitor therapy. We selected high‐risk cases with atherosclerosis with a minimum of three ultrasound examinations, 1 year before, one at the time of initiation of a PCSK9 inhibitor, and 1 year after initiating a PCSK9 inhibitor. Statistical analysis was conducted using the mixed‐effects model with Restricted Maximum Likelihood (REML). We reviewed data from 131 patients with a mean follow‐up of 6 (±4) years. Patients were high‐risk, with the majority having diabetes or hypertension. There was a decrease in TPA, particularly during the first 3 years after initiating PCSK9 inhibitor therapy ( p < 0.05). Furthermore, we observed that individuals with higher baseline serum low‐density lipoprotein cholesterol (LDL‐C) levels experienced a greater decline in TPA ( p < 0.05). PCSK9 inhibitors are effective in achieving plaque regression in high‐risk patients with atherosclerosis. This is important, as plaque regression is associated with a lower risk of stroke, myocardial infarction, or vascular death.