Evolocumab Increases Apolipoprotein A1 Remnant Ratio After 12 Weeks

This post hoc analysis is the first to suggest that evolocumab increases the apolipoprotein A1 remnant ratio following 12 weeks of treatment.

A recent analysis published in Cardiology and Therapy demonstrated that after 12 weeks of treatment, evolocumab, a proprotein convertase subtilisin/kexin type 9 (PCSK9) antibody inhibitor, increases the apolipoprotein A1 (apoA1) remnant ratio.1

Evolocumab is a human monoclonal antibody that targets PCSK9, a serine protease that inhibits low-density lipoprotein receptor recycling,2 thereby lowering the risk for heart attack and stroke in adults with cardiovascular disease caused by atherosclerosis. Research has shown that evolocumab lowers remnant lipoproteins,3 although its effect on the apoA1 remnant ratio is unknown. The apoA1 remnant ratio has been identified as an independent cardiovascular risk factor; thus, higher apoA1 remnant ratios may predict lower cardiovascular risk in some patients.4

Therefore, researchers conducted a post hoc subanalysis of 3 evolocumab studies to evaluate the effects of evolocumab 140 mg every 2 weeks or 420 mg once monthly on the change from baseline in the apoA1 remnant ratio compared with placebo in 2464 patients with mixed dyslipidemia.1

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They found that at week 12, evolocumab 140 mg every 2 weeks and 420 mg once monthly increased the apoA1 remnant ratio by 25.0% and 33.6%, respectively, compared with placebo (P <.0001 for both groups). Those patients with higher apoA1 remnant ratios were significantly more likely to have also achieved a non-high-density lipoprotein cholesterol level of less than 100 mg/dL compared with patients with lower apoA1 remnant ratios.

“This post hoc analysis is the first to suggest that evolocumab increases the apoA1 remnant ratio following 12 weeks of treatment” concluded the authors.1

Disclosure. This study was funded by Amgen Inc. Yuhui Ma, J. Antonio G. López, Blai Coll, and John Nelson have declared affiliations with Amgen Inc.


1. May HT, Muhlestein JB, Ma Y, Lopez JAG, Coll B, Nelson J. Effects of evolocumab on the apoA1 remnant ratio: a pooled analysis of phase 3 studies [published online March 9, 2019]. Cardiol Ther. doi: 10.1007/s40119-019-0133-6

2. Langslet G, Emery M, Wasserman SM. Evolocumab (AMG 145) for primary hypercholesterolemia. Expert Rev Cardiovasc Ther. 2015;13(5):477-488.

3. Toth PP, Sattar N, Blom DJ, et al. Effect of evolocumab on lipoprotein particles. Am J Cardiol. 2018;121(3):308-314.

4. Walldius G, Jungner I, Holme I, Aastveit AH, Kolar W, Steiner E. High apolipoprotein B, low apolipoprotein A-I, and improvement in the prediction of fatal myocardial infarction (AMORIS study): a prospective study. Lancet. 2001;358(9298):P2026-P2033.