Clinical observation of renal artery stenosis treated with PCSK9 inhibitor.

BACKGROUND: Renal artery stenosis (RAS) is a major cause of atherosclerotic secondary hypertension, and interventional therapy carries notable risks. This study evaluated the effects of the PCSK9 inhibitor evolocumab plus statin therapy on lipid profiles, renal artery hemodynamics, and renal function in patients with coronary artery disease (CAD) and RAS.

METHODS: In this single-center retrospective cohort, 57 CAD patients with RAS (July 2019-May 2025) underwent bilateral renal artery ultrasonography and ≥ 1 month follow-up. Patients received either PCSK9 inhibitor therapy (n = 25; evolocumab 140 mg biweekly + atorvastatin 20 mg/day) or standard statin therapy alone (n = 32; atorvastatin 20 mg/day as control). Changes in LDL-C, TC, TG, Lp(a), serum creatinine (Cr), and RAU_RRA/RAU_LRA were compared. Analyses included hierarchical clustering, principal component analysis (PCA), t-tests, and Spearman correlation.

RESULTS: Between-group comparisons after treatment showed that the combination therapy group was significantly superior to the control group in terms of lipids, creatinine, and renal artery parameters (all P < 0.05), while Lp(a) showed an increasing trend. Within-group pre-post comparisons showed improving trends in various indicators, but only some lipid parameters reached statistical significance.

CONCLUSION: In this exploratory study, evolocumab plus statin was associated with improved lipids, renal artery hemodynamics, and potential renal benefit. Due to the small sample size, non-randomized design, and non-significant within-group creatinine change, results should be interpreted cautiously and validated in prospective studies.