Heart failure & cardiomyopathies
Cardiac Allograft Vasculopathy Inhibition With Alirocumab: The CAVIAR Trial
Authors' conclusion
Proprotein convertase subtilisin/kexin 9 inhibition with alirocumab in addition to statin therapy early after HT safely lowers low-density lipoprotein cholesterol but did not reduce coronary artery plaque progression after 1 year compared with rosuvastatin alone in patients with a low baseline low-density lipoprotein cholesterol.
Study context
- Population
- Heart transplant recipients, randomised early after heart transplantation (HT)
- Participants
- 114 recipients
- Comparison
- Alirocumab vs placebo, in addition to rosuvastatin
- Alirocumabn = 57
- Placebon = 57reference
- Primary endpoint
- Change in coronary artery plaque volume on serial intravascular ultrasound
- Follow-up
- Baseline to 1 year after HT
Methodological detailsinvestigator-initiated, prospective, multicentre, double-blind
- Investigator-initiated
- Prospective
- Multicentre
- Double-blind
Primary result
As reported in the abstract
Change in coronary plaque volume (serial IVUS) · 1 year
| Group | Plaque volume baseline → 12 months | P (within group) |
|---|---|---|
| Alirocumab | 176.3±95.2 to 184.5±105.4 mm³ | P=0.23 |
| Placebo | 173.7±96.7 to 183.1±109.8 mm3 | P=0.15 |
Plaque volume baseline → 12 months
Alirocumab176.3±95.2 to 184.5±105.4 mm³
Placebo173.7±96.7 to 183.1±109.8 mm3
P (within group)
AlirocumabP=0.23
PlaceboP=0.15
- Change in plaque volume (mean difference in differences) did not differ between groups
- 1.01 [0.89-1.14]; P=0.86
Further findings
| Outcome | Alirocumab | Placebo |
|---|---|---|
| LDL-C · baseline to 1 year | 72.7 to 31.5 ± 31.7–20.7 mg/dL | 69.0 to 69.2 ± 22.4–28.1 mg/dL |
| Within-group P | P<0.001 | P=0.92 |
Fractional flow reserve, coronary flow reserve, index of microcirculatory resistance
- No significant change with the addition of alirocumab
Safety
- No significant adverse events related to alirocumab
Original publication
Cardiac Allograft Vasculopathy Inhibition With Alirocumab: The CAVIAR Trial. Circulation. Published 10 November 2025. doi:10.
Summarised from the published abstract; every number is checked against it