Effect of evolocumab on the gut microbiota in patients with acute myocardial infarction

<b>Introduction.</b> Growing evidence indicates significant interactions between the intestinal microflora and drugs commonly used to treat coronary heart disease.<b>Hypothesis/Gap Statement.</b> Despite this, research specifically investigating the relationship between proprotein convertase subtilisin/kexin type 9 inhibitors and alterations in the gut microbiota has not been previously published.<b>Aim.</b> This study aimed to identify changes in the gut microbiota potentially associated with evolocumab use in patients with acute myocardial infarction (AMI).<b>Methodology.</b> In this prospective study, 26 AMI patients receiving statins (≥8 weeks) were administered evolocumab (420 mg/4 weeks) alongside standard therapy. Eighteen age-matched healthy volunteers served as controls. 16S rRNA sequencing (NCBI SRA: PRJNA1154993) was subsequently performed on samples from these groups to analyse the gut microbiota community.<b>Results.</b> No significant α-diversity differences were observed among groups (<i>P</i>>0.05). <i>Firmicutes</i> dominated AMI-evolocumab baseline (0 W: 76.32%) versus post-treatment (8 W: 65.22%) and controls (60.40%), while <i>Bacteroidota</i> increased post-treatment (0 W: 15.07%→8 W: 19.99%; control: 27.11%). The second most abundant phyla were <i>Proteobacteria</i> and <i>Actinobacteria</i>. In addition, the differences in the microbial structure among the three groups were as follows: at the genus level, the results of the genus difference analysis revealed significant differences in the abundances of nine types of bacteria among the three groups. Compared with those in the AMI-evolocumab (0 W) group, the abundances of beneficial bacteria, such as <i>Odoribacter</i> and <i>Parabacteroides</i>, were increased in the AMI-evolocumab (8 W) group.<b>Conclusion.</b> Our research showed that evolocumab can regulate the gut microbiota of patients with AMI to promote a healthier state, which is beneficial for patients with AMI.