Efficacy of Evolocumab combined with felodipine in treatment of angina pectoris in elderly patients with chronic coronary syndrome and its influence on Fas protein

XIONG Hui; RONG Zeng-xia; FENG Jian

doi:10.3969/j.issn.1672-5301.2025.11.005

Abstract：Objective To investigate the effect of Evolocumab combined with felodipine in the treatment of angina pectoris in elderly patients with chronic coronary syndrome(CCS)and its influence on Fas protein(Fas/Apol),soluble Fas protein(sFas),and soluble Fas protein ligand(sFas L).Methods Two hundred elderly patients with CCS angina pectoris admitted to Zigong Third People's Hospital from October 2022 to March 2024 were selected.They were divided into the observation group(n=100)and the control group(n=100)according to random number table method by the principle of 1∶1 pairing.The control group was given felodipine,while the observation group was given Evolocumab on the basis of the control group.The angina pectoris symptoms curative effect,electrocardiogram curative effect,cardiac function indicators[left ventricular ejection fraction(LVEF),left ventricular end-systolic volume(LVESV),left ventricular posterior wall thickness(LVPWd)],occurrence of angina,blood lipid metabolism-related indicators[triglyceride(TG),low-density lipoprotein cholesterol(LDL-C),proprotein convertase subtilisin/kexin type 9(PCSK9),total cholesterol(TC)],coronary endothelial function(endothelin-1,nitric oxide),apoptosis-related factors[Fas/Apol,sFas,sFas L levels],related scale scores[Seattle Angina Questionnaire(SAQ)score,Global Registry of Acute Coronary Events(GRACE)score]and myocardial ischemia state were compared between the two groups.Medication compliance and adverse reactions were statistically compared between the two groups during the treatment period;the incidence of major adverse cardiovascular events(MACE)was compared after 12 months of follow-up.Results The curative effect of angina symptoms and electrocardiogram in the observation group were higher than those in the control group(97.00%vs.88.00%,97.00%vs.90.00%,P<0.05).After 12 weeks of the treatment,compared with the control group,LVEF was higher but LVESV,LVPWd,frequency and duration of angina pectoris were lower in the observation group(P<0.05).After 12 weeks of the treatment,the levels of TC,TG,LDL-C and PCSK9 in the observation group were lower than those in the control group(P<0.05).After 12 weeks of the treatment,compared with the control group,the observation group had lower endothelin-1 and higher nitric oxide(P<0.05).After 12 weeks of the treatment,the levels of Fas/Apol,sFas,and sFas L in the observation group were lower than those in the control group[(186.35±15.11)ng/L vs(24.63±18.59)ng/L,(2.56±0.62)ng/L vs.(3.48±0.76)ng/L,(0.11±0.02)ng/L vs.(0.16±0.03)ng/L(P<0.05)].After 12 weeks of the treatment,the SAQ score in the observation group was higher than that in the control group,while the GRACE score was lower than that in the control group(P<0.05).The number of 24 h myocardial ischemia episodes and the duration of ischemia in the observation group were lower than those in the control group(P<0.05).There was no significant difference in medication compliance and incidence of adverse reactions between the two groups during the treatment period(P>0.05).After 12 months of follow-up,5 cases in the observation group and 3 cases in the control group were lost to follow-up;and the total incidence of MACE in the observation group was lower than that in the control group[7.37%(7/95)vs.17.53%(17/97)(P<0.05)].Conclusion The combination of Evolocumab and felodipine for the treatment of angina pectoris in elderly patients with CCS is beneficial in improving clinical efficacy,cardiac function and coronary endothelial function,alleviating angina symptoms,ameliorating the curative effect and quality of life of patients,without obvious increase in adverse reactions.