Abstract 19570: Efficacy and Barriers to Evolocumab Therapy in Real-World, High Risk Secondary Prevention Patients Not at LDL Targets

Introduction: LDL cholesterol lowering, especially with statins, results in reduction of cardiovascular disease. A significant proportion of patients are unable to achieve target LDL levels on statins alone. Recent studies with a novel class of anti-lipid medications, proprotein convertase subtilisin/kexin type-9 (PCSK9) inhibitors have demonstrated marked benefits when added to background statin therapy. However real-world data on effectiveness and barriers to PCSK9 inhibitor therapy initiation, is still lacking. Methods: We performed a single centre retrospective analysis of patients prescribed PCSK9 inhibitors in high-risk patients with stable CAD, post-MI or post-revascularization (ASCVD patients), who were not at target LDL levels. We compared 1-year cholesterol results for 67 consecutive patients who initiated evolocumab, the first PCSK9 inhibitor available in Canada vs. a cohort of 59 patients who were prescribed but did not initiate this therapy. Results: The cohorts were well matched with >90% on high dose statins in both groups. LDL was reduced by 56% from baseline (mean LDL reduced from 2.8 mmol/L at baseline to 1. 1 mmol/L, p 1 year of evolocumab treatment on top of maximal statin therapy - with 79% of the subjects achieving target LDL Conclusions: Among high risk ASCVD patients not at target LDL with conventional therapy, we demonstrated significant improvements in cholesterol levels for those initiating evolocumab, but also found significant real-world barriers to effective implementation of this novel therapy. Strategies to overcome cost barriers and patient hesitancy are required for the broad application of these novel therapies.