PCSK9 inhibition
Evolocumab lowers Lp(a) by 23.6 percent in patients with heterozygous familial hypercholesterolemia (Atheroscler Plus 2026)
Original title: Effects of evolocumab on plasma coenzyme Q10 in patients with heterozygous familial hypercholesterolemia
In a small interventional study of N = 10 patients with heterozygous familial hypercholesterolemia, adding evolocumab to rosuvastatin and ezetimibe reduced Lp(a) from 51.8 nmol/L to 39.1 nmol/L (-23.6%, p = 0.002) over 4 weeks. The reduction occurred without changes in plasma coenzyme Q10 levels. While the magnitude of Lp(a) lowering aligns with larger PCSK9 inhibitor trials, the very small sample size and short follow-up limit generalisability.
Original abstract
Background And Aims: Muscle symptoms are common with statin therapy, and reduced plasma coenzyme Q10 (CoQ10) has been proposed as a potential mechanism. Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors are widely used in patients with statin intolerance or severe hypercholesterolemia, including familial hypercholesterolemia (FH), but their effects on plasma CoQ10 remain unclear.
Methods: We evaluated serum lipid profiles and plasma CoQ10 baseline and 4 weeks after adding evolocumab in patients with heterozygous FH receiving rosuvastatin 10-20 mg/day and ezetimibe 10 mg/day (N = 10; mean age, 52 years; 6 men). Plasma CoQ10 concentrations were determined by high-performance liquid chromatography.
Results: Evolocumab markedly reduced LDL cholesterol and lipoprotein(a) [Lp(a)] (121 mg/dL to 64 mg/dL, -50.0%, p < 0.001; 51.8 nmol/L to 39.1 nmol/L, -23.6%, p = 0.002), whereas median CoQ10 levels were unchanged (1028.5 nmol/L to 1002.5 nmol/L, -0.2%, p = 0.33). Changes in CoQ10 did not correlate with reductions in LDL cholesterol or Lp(a).
Conclusions: These findings indicate that evolocumab lowers atherogenic lipoproteins without reducing plasma CoQ10, suggesting a potential advantage for patients susceptible to statin-associated muscle symptoms.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 25 August 2026. Methods.