부산대학교 도서관

Introduction: Diabetes is associated with progressive coronary atherosclerosis. Reduction in LDL-C with high intensity statins promote plaque regression in patients with diabetes and have also been associated with changes in CRP. Treatment with the proprotein convertase subtilisin kexin type 9 (PCSK9) inhibitor, evolocumab, permits investigation of whether pure intensive lipid lowering can promote disease regression in the setting of diabetes.Methods: The GLAGOV trial compared the effects of treatment for 78 weeks with evolocumab or placebo on progression of coronary atherosclerosis, measured by serial intravascular ultrasonography, in statin-treated patients with coronary artery disease. Clinical demographics, biochemistry, plaque burden and progression were compared in patients with (n=175) and without (n=671) diabetes at baseline.Results: Patients with diabetes were older (61.2 vs 59.2 years, P=0.01), more likely to have hypertension (94.3% vs 79.0%, P<0.001), non-coronary atherosclerotic disease (19.4% vs 10.3%, P=0.001) and had a greater body mass index (31.9 vs 28.8 kg/m, P<0.001) and lower LDL-C (83 vs 89 mg/dL, P=0.002) and HDL-C (41 vs 45 mg/dL, P<0.001). In patients with diabetes, evolocumab decreased LDL-C by 56.4% (P<0.001 compared with baseline). At baseline, patients with diabetes demonstrated a non-significant trend towards greater levels of percent atheroma volume (PAV: 37.8 vs 36.5%, P=0.08) and total atheroma volume (TAV: 200.2 vs 186.3 mm, P=0.05). Evolocumab produced similar reductions in PAV (-0.89 vs -0.95%, P=0.87) in patients with and without diabetes. However, the TAV reduction with evolocumab was greater in patients without diabetes (-7.6 mm, P<0.0001), than those with diabetes (-2.9 mm, P=0.22; P=0.03). A similar proportion of patients demonstrated any degree of regression of PAV (62.5 vs 64.8%, P=0.69) and TAV (56.8 vs 62.7%, P=0.31) with evolocumab in the groups with and without diabetes, respectively.Conclusion: The PCSK9 inhibitor, evolocumab, produced a similar degree of regression of coronary atherosclerosis in statin-treated patients with and without diabetes. This highlights the importance of intensive lipid lowering in diabetes.