Introduction and Objective: Diabetic peripheral atherosclerosis is an important marker of macrovascular complications in diabetes. Changes in the thickness of carotid atherosclerotic plaques can indicate early macrovascular alterations in diabetes. The aim of this study is to observe the impact of PCSK9 inhibitors (PCSK9i) on changes in carotid plaque thickness in patients with diabetes without diagnosed ASCVD.Methods: This retrospective cohort study included adults with type 2 diabetes mellitus (T2DM) but without diagnosed ASCVD who were treated at the Department of Endocrinology and Metabolism, Zhujiang Hospital, from July 2022 to December 2024. The groups were divided into two groups based on their lipid-lowering regimen: non-PCSK9i group (statins plus non-PCSK9i lipid-lowering medications) or PCSK9i group (statins plus evolocumab 140 mg administered biweekly). Carotid atherosclerotic plaque thickness measured by carotid ultrasound and lipid profiles were evaluated before and after 24 weeks of stable lipid-lowering therapy, and the results were analyzed using generalized estimating equations.Results: After conducting 1:1 propensity score matching (resulting in 184 patient pairs), baseline characteristics such as age, sex, and lipid profiles were balanced between the groups. At the 24-week mark, PCSK9i group was significantly associated with carotid plaque thickness reduction (OR = 1.87; 95% CI 1.36-2.56; P<0.001) and a significantly higher proportion of carotid plaque thickness regression compared to the non-PCSK9i group (45.83% vs. 31.01%; P<0.001). PCSK9i group experienced significant reductions in total cholesterol (TC), triglycerides (TG), LDL-c, and an increase in HDL-c (all P<0.001), whereas the non-PCSK9i group only showed reductions in TC and LDL-c (all P<0.001), with no significant changes in HDL-c or TG.Conclusion: Lipid-lowering regimens that include PCSK9i are more effective in reversing carotid plaque thickness in patients with T2DM without diagnosed ASCVD.
J. Bi: None. X. Li: None. Y. Cheng: None. J. Chen: None. P. Cao: None. W. Wen: None. J. Sun: None.
National Natural Science Foundation of China (8227094); Guangdong Basic and Applied Basic Research Foundation (2022A1515010244, 2024A1515013160); 2024 Shantou Municipal Healthcare Science and Technology Plan (240423126497225)
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