Effect of proprotein convertase subtilisin kexin 9 inhibitors on platelet aggregation in patients with and without diabetes.

BACKGROUND AND AIM: The impact of proprotein convertase subtilisin/kexin 9 (PCSK9) inhibitors on platelet reactivity in the setting of diabetes mellitus (DM) has not been adequately investigated.

METHODS AND

RESULTS

Out of 52 outpatients with atherosclerotic cardiovascular disease (ASCVD) with an indication for PCSK9 inhibitor alirocumab, 37 patients (mean age 68.1 ± 5.6 years, 62% males) were included in the study and retrospectively divided into two groups according to the presence of DM (DM+/DM-). A blood sample for platelet function testing was collected at baseline (T0), before initiation of alirocumab, and after 3 months of therapy (T90). Light transmission aggregometry was performed to study platelet aggregation, and results were expressed as percentage of maximum platelet aggregation (MPA). At 90-day follow-up, a significant reduction of total cholesterol and low-density lipoprotein cholesterol levels compared to baseline was observed in both DM+ and DM-groups. At baseline, MPA were comparable between the two groups. At T90, only in the DM + cohort, platelet aggregation induced by adenosine diphosphate (ADP) and arachidonic acid (AA) was significantly reduced compared to baseline (ADP 20 μM: 56.00 ± 28.67% vs 63.16 ± 33.69%, at T90 vs T0 respectively, p = 0.011; AA 1 mM: 28.68 ± 40.10% vs 41.74 ± 46.85%, p = 0.025). No significant change in platelet function from baseline was observed in patients DM- (p > 0.05 for all comparisons).

CONCLUSION

The PCSK9 inhibitor alirocumab significantly reduced AA and ADP residual platelet aggregation after 90 days of therapy in patients with ASCVD and diabetes, but not in those without diabetes.