Research Story Tip: Next-Gen Cholesterol Drug Works Fast After a Heart Attack to Lower ‘Bad’ Cholesterol


Deposits of low-density lipoprotein (LDL) cholesterol can narrow or block a coronary artery, increasing the risk of a heart attack. A new study from Johns Hopkins Medicine shows that the drug evolocumab — an inhibitor of the PCSK9 protein which increases LDL in the blood — can reduce LDL to safe levels within 30 days following a first heart attack to help prevent a second. Credit: Graphic by M.E. Newman, Johns Hopkins Medicine, using public domain image of narrowed artery courtesy of Bruce Blaus

Within a month following a heart attack, people are at increased risk for a second one. As a result, physicians treat these patients with medications to rapidly reduce cardiovascular risk factors for another event. Although statins are designed to reduce the risk from one underlying problem, low-density lipoprotein (LDL) or “bad” cholesterol, they often aren’t able drop it to recommended levels within 30 days.

Now, testing a next-generation cholesterol-lowering drug known as a PCSK9 inhibitor, Johns Hopkins Medicine researchers showed they could lower blood cholesterol to safer levels faster when it is added to traditional therapies.

Although larger studies are needed to assess other outcomes, the researchers say the early finding, published July 27, 2020, in Circulation, suggests that a PCSK9 inhibitor is safe to use, significantly lowers LDL cholesterol during hospitalization and achieves the reduction within the month following a heart attack.

“As these are the most vulnerable patients, we need to most aggressively treat them to lower their risk factors,” says Thorsten Leucker, M.D., Ph.D., assistant professor of medicine at the Johns Hopkins University School of Medicine. “With our study showing that we can lower these bad cholesterol levels with a PCSK9 inhibitor — which in stable patients decreases cardiovascular events — we hope that this approach also will reduce secondary events and perhaps even prevent early deaths in patients after an acute heart attack.”

For the study, 57 people were randomly assigned to get either one dose of the cholesterol-lowering drug evolocumab — which reduces activity of the PCSK9 protein and increases LDL cholesterol levels in the bloodstream — or a placebo after they were admitted to the hospital for a heart attack. Over the course of the 30-day study period, the patients on evolocumab had their bad cholesterol reduced on average by 28.6 milligrams per deciliter more than patients given the placebo.

Upon hospital discharge, 80.1% of patients given the PCSK9 inhibitor were at or below the American Heart Association/American College of Cardiology recommended LDL cholesterol targets of 70 milligrams per deciliter compared with 38.1% of people given the placebo.

For future studies, the researchers plan to see whether the drug also reduces inflammation in the heart muscle and arteries to improve the healing and functioning of the heart following a severe heart attack.

Leucker and co-author Michael Blaha, M.D., M.P.H., professor of medicine at the Johns Hopkins University School of Medicine, are paid advisory board members to Amgen Inc. Amgen provided monetary and material support for this study. This arrangement has been reviewed and approved by The Johns Hopkins University in accordance with its conflict of interest policies.