{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T09:42:08Z","timestamp":1785404528759,"version":"3.56.0"},"reference-count":16,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:00:00Z","timestamp":1782950400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004242","name":"Princess Nourah bint Abdulrahman University","doi-asserted-by":"crossref","award":["PNURSP2026R418"],"award-info":[{"award-number":["PNURSP2026R418"]}],"id":[{"id":"10.13039\/501100004242","id-type":"DOI","asserted-by":"crossref"}]},{"award":["PNURSP2026R418"],"award-info":[{"award-number":["PNURSP2026R418"]}],"id":[{"id":"https:\/\/ror.org\/05b0cyh02","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmaceuticals"],"abstract":"<jats:p>Background: Intensive low-density lipoprotein cholesterol (LDL-C) reduction is essential for secondary prevention after acute coronary syndrome (ACS). Although randomized trials support the use of proprotein convertase subtilisin\/kexin type 9 (PCSK9) inhibitors, real-world evidence on long-term lipid control and the optimal timing of initiation remains limited. Objective: To evaluate lipid outcomes and atherosclerotic cardiovascular disease (ASCVD) events associated with evolocumab after ACS and to assess whether timing of initiation influences these outcomes in routine clinical practice. Methods: This multicenter, retrospective cohort study included adults who were initiated on evolocumab following ACS between 2017 and 2024. Lipid parameters were assessed at predefined follow-up time points (3 months, 6 months, 1 year, 2 years, and up to 3 years) using an available-case approach. Patients were categorized as early initiators (\u22641 month) or late initiators (&gt;1 month). Recurrent ASCVD events, hospitalization burden, and mortality were analyzed using multivariable regression. A propensity score-matched sensitivity analysis was also performed. Results: Among 525 included patients (mean age 53.1 \u00b1 11.6 years; 80.2% male), baseline LDL-C was 3.68 \u00b1 1.66 mmol\/L. LDL-C decreased to approximately 1.8\u20132.0 mmol\/L within 3 months, corresponding to an approximate 45\u201350% reduction from baseline, with consistent reductions observed across available follow-up time points. Recurrent ASCVD events occurred in 14.8% of patients, and in-hospital mortality was 2.3%. Although early initiators had higher baseline risk, adjusted analyses showed no statistically significant association between early initiation and recurrent ASCVD (adjusted OR 1.50; 95% CI 0.82\u20132.70; p = 0.17). Similarly, no statistically significant differences in lipid outcomes were observed between early and late initiation groups after adjustment. Findings were consistent in propensity score-matched analyses. Conclusions: In this real-world post-ACS cohort, evolocumab was associated with substantial and sustained LDL-C reduction across follow-up time points. No significant associations were observed between timing of initiation and lipid or ASCVD outcomes after adjustment. These findings should be interpreted cautiously, given the observational design, available-case analysis, and potential for residual confounding.<\/jats:p>","DOI":"10.3390\/ph19071035","type":"journal-article","created":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T14:51:25Z","timestamp":1783003885000},"page":"1035","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Timing of Evolocumab Initiation After Acute Coronary Syndrome and Long-Term Lipid and Cardiovascular Outcomes: A Multicenter Real-World Cohort Study"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1549-0941","authenticated-orcid":false,"given":"Lama","family":"Alfehaid","sequence":"first","affiliation":[{"name":"Department of Pharmacy Practice, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh 14611, Saudi Arabia"},{"name":"King Abdullah International Medical Research Center, Riyadh 11481, Saudi Arabia"},{"name":"Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh 14611, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0479-566X","authenticated-orcid":false,"given":"Ehsan A.","family":"Habeeb","sequence":"additional","affiliation":[{"name":"King Abdullah International Medical Research Center, Riyadh 11481, Saudi Arabia"},{"name":"Department of Pharmacy Practice, College of Pharmacy, Taibah University, Madinah 42353, Saudi Arabia"},{"name":"Prince Mohammad Bin Abdulaziz Hospital, National Guard Health Affairs, Madinah 42324, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amal M.","family":"Badawoud","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice, College of Pharmacy, Princess Nourah Bint Abdulrahman University, Riyadh 11671, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-5429-6371","authenticated-orcid":false,"given":"Salwa A.","family":"Alsuhaibani","sequence":"additional","affiliation":[{"name":"Prince Sultan Cardiac Center, Qassim Health Cluster, Ministry of Health, Buraydah 52366, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rasha","family":"Almutairi","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice, College of Pharmacy, Princess Nourah Bint Abdulrahman University, Riyadh 11671, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafeef","family":"Alyahya","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice, College of Pharmacy, Princess Nourah Bint Abdulrahman University, Riyadh 11671, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shoug","family":"Alquraishi","sequence":"additional","affiliation":[{"name":"College of Pharmacy, Qassim University, Buraydah 52571, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanin","family":"Alharbi","sequence":"additional","affiliation":[{"name":"College of Pharmacy, Qassim University, Buraydah 52571, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Alshammari","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh 14611, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-7044-0161","authenticated-orcid":false,"given":"Hanan","family":"Alfulayyih","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh 14611, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Waad","family":"Almasoud","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh 14611, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali A.","family":"Almakrami","sequence":"additional","affiliation":[{"name":"Clinical Pharmacy Department, King Fahad Medical City, Riyadh 12231, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulaali","family":"Almutairi","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice, College of Pharmacy, Alfaisal University, Riyadh 11533, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2308-8407","authenticated-orcid":false,"given":"Majed S.","family":"Al Yami","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh 14611, Saudi Arabia"},{"name":"King Abdullah International Medical Research Center, Riyadh 11481, Saudi Arabia"},{"name":"Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh 14611, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1093\/eurheartj\/ehz455","article-title":"2019 ESC\/EAS guidelines for the management of dyslipidaemias: Lipid modification to reduce cardiovascular risk","volume":"41","author":"Mach","year":"2020","journal-title":"Eur. Heart J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"4359","DOI":"10.1093\/eurheartj\/ehaf190","article-title":"2025 Focused Update of the 2019 ESC\/EAS Guidelines for the Management of Dyslipidaemias","volume":"46","author":"Mach","year":"2025","journal-title":"Eur. Heart J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e1154","DOI":"10.1161\/CIR.0000000000001457","article-title":"2026 ACC\/AHA\/AACVPR\/ABC\/ACPM\/ADA\/AGS\/APhA\/ASPC\/NLA\/PCNA Guideline on the Management of Dyslipidemia: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"153","author":"Blumenthal","year":"2026","journal-title":"Circulation"},{"key":"ref_4","unstructured":"Center for Drug Evaluation and Research (2024, June 25). Drug Trials Snapshots: Repatha (Evolocumab). 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Soc."}],"container-title":["Pharmaceuticals"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8247\/19\/7\/1035\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T04:20:02Z","timestamp":1783398002000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8247\/19\/7\/1035"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,2]]},"references-count":16,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["ph19071035"],"URL":"https:\/\/doi.org\/10.3390\/ph19071035","relation":{},"ISSN":["1424-8247"],"issn-type":[{"value":"1424-8247","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,2]]}}}