OBJECTIVE

To study the incidence of recurrent acute vascular events in high cardiovascular risk patients living in St. Petersburg, the impact of early initiation of intensive lipid-lowering therapy using PCSK9 inhibitors on survival and hospitalization rate in patients with extreme cardiovascular risk.

MATERIALS AND METHODS

The incidence of recurrent acute cardiovascular events (CVEs) in patients with high cardiovascular risk in 2021—2023 was analyzed. The achievement of target levels of low-density lipoprotein cholesterol (LDL-C) with intensified therapy by PCSK9 inhibitors and its effect on survival were studied. The study included 204 patients with recurrent CVEs over the year: 98 patients of the study group received therapy with PCSK9 inhibitors and standard lipid-lowering therapy (LLT); 106 patients of the control group received standard LLT.

RESULTS

Two or more CVEs have been observed in 2021 in 5870 patients, in 2022 — in 9647, in 2023 — in 11 196. Among them, 1601 patients died in 2021, 1676 — in 2022 and 1740 — in 2023. A reduction in the level of LDL-C by 63.8% has been noted in presence of receiving a combination of PCSK9 inhibitors with statins and/or ezetimibe in patients of the study group. The target value of LDL-C less than 1 mmol/L was reached by 76.5% of patients in the study group after one month of PCSK9 inhibitors administration, by 78.6% — at the end of the study.

Cumulative survival amounted to 96.6% in the study group and 86.1% in the control group. The cumulative incidence of recurrent non-fatal CVEs in the control group was higher than in the study group (34.6 and 18%) at 34 months (median) after the index event.

CONCLUSION

It is advisable to include high-intensity lipid-lowering drugs with initiation at the time of hospitalization for an index event in order to improve secondary prevention and successful implementation of the «Fight against cardiovascular diseases» national project.