You are here

Article Text

Article menu
Download PDFPDF
Cerebrovascular disease
Original research
PSCK9 inhibitors reduced early recurrent stroke in patients with symptomatic intracranial atherosclerotic stenosis
  1. Li Wu1,
  2. Bo Zhang2,
  3. Chenghao Li3,
  4. Zhuolin Zhuang3,
  5. Kang Liu1,
  6. Hualin Chen1,
  7. Shuanggen Zhu4,
  8. Juehua Zhu5,
  9. Zheng Dai6,
  10. Huameng Huang7,
  11. Yongjun Jiang1
  1. 1 Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
  2. 2 Department of Neurology, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
  3. 3 Department of Radiology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
  4. 4 Department of Neurology, Shenzhen Longhua District Central Hospital, The Affiliated Hospital of Guangdong Medical University, Shenzhen, Guangdong, China
  5. 5 Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
  6. 6 Department of Neurology, Wuxi People’s Hospital, Wuxi, Jiangsu, China
  7. 7 Department of Neurology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
  1. Correspondence to Dr Yongjun Jiang, Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China; jiangyjnju{at}gmail.com; Dr Huameng Huang; 15219078888{at}139.com

Abstract

Background Symptomatic intracranial atherosclerotic stenosis (ICAS) is prone to cause early recurrent stroke (ERS). Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors lower low-density lipoprotein cholesterol (LDL-C) levels and prevent cardiovascular events. This multicentre, hospital-based prospective cohort study was designed to investigate whether PCSK9 inhibitors would prevent ERS in patients with symptomatic ICAS.

Methods From 1 October 2020 to 30 September 2022, consecutive patients with acute ischaemic stroke attributed to ICAS admitted within 1 week after onset were enrolled and followed up for 1 month. Patients were divided into two groups, the PCSK9 inhibitors group receiving PCSK9 inhibitors add-on therapy, and the control group receiving statins and/or ezetimibe. The primary outcome was ERS. Cox proportional hazard models and Kaplan-Meier survival curve were used to estimate the association between PCSK9 inhibitors and ERS.

Results At the end of follow-up, the LDL-C levels were further lowered by PCSK9 inhibitors add-on therapy (n=232, from 3.06±1.16 mmol/L to 2.12±1.19 mmol/L) than statins and/or ezetimibe treatment (n=429, from 2.91±1.05 mmol/L to 2.64±0.86 mmol/L, p<0.001). The Kaplan-Meier survival curves showed that PCSK9 inhibitors add-on therapy significantly reduced ERS (5.59%, 24/429, vs 2.16%, 5/232; log-rank test, p=0.044). The multivariate Cox regression analysis revealed that, after adjusting for confounders with a p value less than 0.05 in univariate analysis or of particular importance, the HR was 0.335 (95% CI 0.114 to 0.986, p=0.047), compared with the control group.

Conclusions In our study, PCSK9 inhibitors add-on therapy further reduced LDL-C levels and ERS in patients with symptomatic ICAS.

  • PCSK9 inhibitors
  • early recurrent stroke
  • stroke
  • atherosclerosis
  • intracranial atherosclerotic stenosis

Data availability statement

Data are available upon reasonable request. The datasets used and/or analysed during the current study are available from the corresponding authors on reasonable request.

https://doi.org/10.1136/jnnp-2023-332392

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Data availability statement

    Data are available upon reasonable request. The datasets used and/or analysed during the current study are available from the corresponding authors on reasonable request.

    View Full Text

    Footnotes

    • LW, BZ and CL contributed equally.

    • Contributors The conception/design of the work: YJ, HH. The acquisition of data: LW, BZ, KL, HC, JZ, ZD. The analysis and interpretation of data: SZ, HH. The analysis of neuroimaging: CL, ZZ. Writing—original draft preparation: LW. Writing—review and editing: YJ. YJ is responsible for the overall content as guarantor. All authors have read and approved the submitted version of the manuscript, and agreed to be personally accountable for the author’s own contributions and questions related to the accuracy or integrity of any part of the work.

    • Funding This study was financially supported by the National Natural Science Foundation of China (82371345), Basic and Applied Basic Research Foundation of Guangdong Province (2021A1515012351), Guangzhou Science and Technology Project (grant number SL2024A03J01142), the Opening Lab Programme of Guangzhou Medical University (0506308) and the Undergraduate Innovation Programme of Guangzhou Medical University (N/A) to YJ; and by the National Natural Science Foundation of China (81501009) and the Guangzhou Science and Technology Project (202201020393) to LW; and by the Scientific Research Projects of Medical and Health Institutions of Longhua District, Shenzhen (2021013), the High Level Project of Medicine in Longhua, ShenZhen (HLPM201907020102) and the Construction Funds of Key Medical Disciplines in Longhua District, Shenzhen (MKD202007090208) to SZ. The funding sources had no involvement in the design of the study and collection, analysis, interpretation of data, or in writing the manuscript.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.