Article Impact Level: HIGH Data Quality: STRONG Summary of JACC: Cardiovascular Imaging, 18(5), 589–599. https://doi.org/10.1016/j.jcmg.2025.01.005 Dr. Donghee Han et al.
Points
- This study evaluated the effects of evolocumab on coronary artery plaque and inflammation over 18 months using advanced CTA and PET imaging in 47 patients with coronary artery disease.
- While total plaque volume remained stable, noncalcified and low-attenuation plaque volumes significantly decreased, indicating a reduction in high-risk soft plaque components.
- Calcified plaque volume increased, which may reflect plaque stabilization, and microcalcification activity and inflammatory indicators also declined significantly over the treatment period.
- The results suggest that evolocumab shifts plaque composition toward a more stable phenotype while reducing inflammatory activity in coronary arteries.
- These findings highlight evolocumab’s potential to address lipid control and plaque stabilization in managing coronary artery disease.
Summary
This prospective study evaluated the impact of evolocumab on coronary plaque composition and microcalcification activity in patients with coronary artery disease (CAD) using advanced imaging techniques. Forty-seven patients (mean age 61.8 ± 10.1 years, 87% male) with extensive noncalcified coronary plaque were enrolled, and both coronary computed tomography angiography (CTA) and 18F-sodium fluoride (NaF) positron emission tomography (PET) were used to assess plaque changes at baseline and after 18 months of evolocumab treatment. The primary goal was to determine the effect of evolocumab on plaque volume, composition, and microcalcification activity.
At the 18-month follow-up, no significant change was observed in total plaque volume (716.2 ± 431.4 µL to 710.8 ± 456.2 µL; P = 0.705). However, there was a significant reduction in noncalcified plaque volume (607.3 ± 346.8 µL to 562.1 ± 337.3 µL; P < 0.001) and low-attenuation noncalcified plaque (37.1 ± 28.9 µL to 20.4 ± 15.4 µL; P < 0.001), which are considered higher-risk plaques due to their soft and unstable nature. Conversely, calcified plaque volume increased (108.9 ± 133.7 µL to 148.7 ± 175.3 µL; P < 0.001). Additionally, there was a significant reduction in coronary microcalcification activity (1.35 ± 1.68 to 1.08 ± 1.37; P = 0.004) and lesion target-to-background ratio (1.73 ± 0.85 to 1.62 ± 0.83; P = 0.005), indicating a reduction in plaque activity and inflammation.
The study concluded that 18 months of evolocumab treatment in patients with extensive noncalcified plaque resulted in a shift toward a lower-risk plaque phenotype with reduced microcalcification activity. These findings suggest that evolocumab not only reduces cholesterol levels but also mitigates inflammation and plaque instability, potentially lowering the risk of heart attack in CAD patients. This study supports evolocumab as a therapeutic approach to target lipid levels and plaque inflammation in cardiovascular disease management.
Link to the article: https://www.sciencedirect.com/science/article/abs/pii/S1936878X25000907
References Han, D., Tzolos, E., Park, R., Gransar, H., Hyun, M., Friedman, J. D., Hayes, S. W., Thomson, L. E. J., Kwan, A. C., Budoff, M., Shah, P. K., Kwieciński, J., Wetzel, S., Findling, C., Slomka, P. J., Dey, D., Tamarappoo, B. K., & Berman, D. S. (2025). Effects of evolocumab on coronary plaque composition and microcalcification activity by coronary pet and ct angiography. JACC: Cardiovascular Imaging, 18(5), 589–599. https://doi.org/10.1016/j.jcmg.2025.01.005
