2.2. Patients

In our institute, most patients undergo carotid artery ultrasonography every 1–2 years to identify those at high risk of developing coronary artery disease [10]. Intensive lipid-lowering therapies, including the use of statins and PCSK9 inhibitors, are administered to high-risk patients to prevent the development of acute coronary syndrome [10]. In Japan, PCSK9 inhibitors have been indicated for the treatment of patients with familial hypercholesterolemia or hypercholesterolemia who have a high risk for cardiovascular events and do not adequately respond to statins. Therefore, evolocumab was administered to hypercholesterolemic patients with confirmed cardiovascular risk factors who did not achieve optimal LDL-cholesterol goals or exhibited progression of carotid IMT despite statin therapy. We retrospectively analyzed the clinical and laboratory data of patients who had regularly visited the Chiba Cerebral and Cardiovascular Center between April 2016 and March 2019.

The inclusion criteria were—(i) age ≥20 years, (ii) treatment with evolocumab for ≥12 months, (iii), carotid artery ultrasonography at the initiation of evolocumab, as well as 12 months (±1 month) before and 12 months (±1 month) afterwards, (iv) treatment with a statin for ≥12 months before the initiation of evolocumab. The exclusion criterion was renal replacement therapy.