Effects of Alirocumab and Evolocumab on Cardiovascular Mortality and LDL-C: Stratified According to the Baseline LDL-C Levels
Background: A meta-analysis was conducted to determine whether the cardiovascular mortality and lipid-lowering effects of alirocumab and evolocumab are influenced by various baseline low-density lipoprotein cholesterol (LDL-C) levels....
Saved in:
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
IMR Press
2025-04-01
|
| Series: | Reviews in Cardiovascular Medicine |
| Subjects: | |
| Online Access: | https://www.imrpress.com/journal/RCM/26/4/10.31083/RCM26980 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849310681107529728 |
|---|---|
| author | Hui Ma Wenfang Ma Yang Liu Lixing Chen Peng Ding |
| author_facet | Hui Ma Wenfang Ma Yang Liu Lixing Chen Peng Ding |
| author_sort | Hui Ma |
| collection | DOAJ |
| description | Background: A meta-analysis was conducted to determine whether the cardiovascular mortality and lipid-lowering effects of alirocumab and evolocumab are influenced by various baseline low-density lipoprotein cholesterol (LDL-C) levels. Methods: We searched for literature published before June 2023. Eligible randomized controlled trials (RCTs) included adults treated with alirocumab or evolocumab and reported LDL-C changes and cardiovascular deaths. The primary endpoints were cardiovascular mortality and percent changes in LDL-C from baseline. Results: Forty-one RCTs were included in the meta-analysis. Evolocumab did not significantly affect the outcome of cardiovascular mortality whether the baseline data were greater than 100 mg/dL or less than 100 mg/dL. However, the stratified result showed that alirocumab decreased the risk of cardiovascular mortality in patients with a baseline LDL-C level of ≥100 mg/dL (relative risk (RR) 0.45; 95% CI: 0.22 to 0.92; p = 0.03). In terms of lipid-lowering efficacy, alirocumab (mean difference (MD) –56.62%; 95% CI: –60.70% to –52.54%; p < 0.001) and evolocumab (MD –68.10%; 95% CI: –74.85% to –61.36%; p < 0.001) yielded the highest percentage reduction in LDL-C level when baseline levels were 70–100 mg/dL, while the smallest reduction in alirocumab (MD –37.26%; 95% CI: –44.06% to –30.46%; p < 0.001) and evolocumab (MD –37.55%; 95% CI: –40.47% to –34.63%; p < 0.001) occurred with baseline LDL-C levels of ≥160 mg/dL. Conclusions: Alirocumab and evolocumab presented a better lipid-lowering effect when the baseline LDL-C levels were <100 mg/dL. Alirocumab was associated with a significant reduction in cardiovascular mortality at baseline LDL-C levels of ≥100 mg/dL. This finding can have significant implications for the development of personalized drug therapy. The PROSPERO Registration: CRD42023446723, https://www.crd.york.ac.uk/PROSPERO/view/CRD42023446723. |
| format | Article |
| id | doaj-art-add110511ff940a7ba98de1eb39d9115 |
| institution | Kabale University |
| issn | 1530-6550 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | IMR Press |
| record_format | Article |
| series | Reviews in Cardiovascular Medicine |
| spelling | doaj-art-add110511ff940a7ba98de1eb39d91152025-08-20T03:53:39ZengIMR PressReviews in Cardiovascular Medicine1530-65502025-04-012642698010.31083/RCM26980S1530-6550(24)01735-6Effects of Alirocumab and Evolocumab on Cardiovascular Mortality and LDL-C: Stratified According to the Baseline LDL-C LevelsHui Ma0Wenfang Ma1Yang Liu2Lixing Chen3Peng Ding4Department of Cardiology, The First Affiliated Hospital of Kunming Medical University, 650032 Kunming, Yunnan, ChinaDepartment of Cardiology, The First Affiliated Hospital of Kunming Medical University, 650032 Kunming, Yunnan, ChinaDepartment of Cardiology, The First Affiliated Hospital of Kunming Medical University, 650032 Kunming, Yunnan, ChinaDepartment of Cardiology, The First Affiliated Hospital of Kunming Medical University, 650032 Kunming, Yunnan, ChinaDepartment of Cardiology, The First Affiliated Hospital of Kunming Medical University, 650032 Kunming, Yunnan, ChinaBackground: A meta-analysis was conducted to determine whether the cardiovascular mortality and lipid-lowering effects of alirocumab and evolocumab are influenced by various baseline low-density lipoprotein cholesterol (LDL-C) levels. Methods: We searched for literature published before June 2023. Eligible randomized controlled trials (RCTs) included adults treated with alirocumab or evolocumab and reported LDL-C changes and cardiovascular deaths. The primary endpoints were cardiovascular mortality and percent changes in LDL-C from baseline. Results: Forty-one RCTs were included in the meta-analysis. Evolocumab did not significantly affect the outcome of cardiovascular mortality whether the baseline data were greater than 100 mg/dL or less than 100 mg/dL. However, the stratified result showed that alirocumab decreased the risk of cardiovascular mortality in patients with a baseline LDL-C level of ≥100 mg/dL (relative risk (RR) 0.45; 95% CI: 0.22 to 0.92; p = 0.03). In terms of lipid-lowering efficacy, alirocumab (mean difference (MD) –56.62%; 95% CI: –60.70% to –52.54%; p < 0.001) and evolocumab (MD –68.10%; 95% CI: –74.85% to –61.36%; p < 0.001) yielded the highest percentage reduction in LDL-C level when baseline levels were 70–100 mg/dL, while the smallest reduction in alirocumab (MD –37.26%; 95% CI: –44.06% to –30.46%; p < 0.001) and evolocumab (MD –37.55%; 95% CI: –40.47% to –34.63%; p < 0.001) occurred with baseline LDL-C levels of ≥160 mg/dL. Conclusions: Alirocumab and evolocumab presented a better lipid-lowering effect when the baseline LDL-C levels were <100 mg/dL. Alirocumab was associated with a significant reduction in cardiovascular mortality at baseline LDL-C levels of ≥100 mg/dL. This finding can have significant implications for the development of personalized drug therapy. The PROSPERO Registration: CRD42023446723, https://www.crd.york.ac.uk/PROSPERO/view/CRD42023446723.https://www.imrpress.com/journal/RCM/26/4/10.31083/RCM26980alirocumabevolocumablow-density lipoprotein cholesterol (ldl-c)baseline stratificationcardiovascular mortalitylipid-lowering efficacy |
| spellingShingle | Hui Ma Wenfang Ma Yang Liu Lixing Chen Peng Ding Effects of Alirocumab and Evolocumab on Cardiovascular Mortality and LDL-C: Stratified According to the Baseline LDL-C Levels Reviews in Cardiovascular Medicine alirocumab evolocumab low-density lipoprotein cholesterol (ldl-c) baseline stratification cardiovascular mortality lipid-lowering efficacy |
| title | Effects of Alirocumab and Evolocumab on Cardiovascular Mortality and LDL-C: Stratified According to the Baseline LDL-C Levels |
| title_full | Effects of Alirocumab and Evolocumab on Cardiovascular Mortality and LDL-C: Stratified According to the Baseline LDL-C Levels |
| title_fullStr | Effects of Alirocumab and Evolocumab on Cardiovascular Mortality and LDL-C: Stratified According to the Baseline LDL-C Levels |
| title_full_unstemmed | Effects of Alirocumab and Evolocumab on Cardiovascular Mortality and LDL-C: Stratified According to the Baseline LDL-C Levels |
| title_short | Effects of Alirocumab and Evolocumab on Cardiovascular Mortality and LDL-C: Stratified According to the Baseline LDL-C Levels |
| title_sort | effects of alirocumab and evolocumab on cardiovascular mortality and ldl c stratified according to the baseline ldl c levels |
| topic | alirocumab evolocumab low-density lipoprotein cholesterol (ldl-c) baseline stratification cardiovascular mortality lipid-lowering efficacy |
| url | https://www.imrpress.com/journal/RCM/26/4/10.31083/RCM26980 |
| work_keys_str_mv | AT huima effectsofalirocumabandevolocumaboncardiovascularmortalityandldlcstratifiedaccordingtothebaselineldlclevels AT wenfangma effectsofalirocumabandevolocumaboncardiovascularmortalityandldlcstratifiedaccordingtothebaselineldlclevels AT yangliu effectsofalirocumabandevolocumaboncardiovascularmortalityandldlcstratifiedaccordingtothebaselineldlclevels AT lixingchen effectsofalirocumabandevolocumaboncardiovascularmortalityandldlcstratifiedaccordingtothebaselineldlclevels AT pengding effectsofalirocumabandevolocumaboncardiovascularmortalityandldlcstratifiedaccordingtothebaselineldlclevels |