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在FOURIER试验中的炎症和胆固醇风险
Erin A Bohula1, Robert P Giugliano2, Lawrence A Leiter3
1TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.A.B., R.P.G., J.-G.P., S.A.M., M.S.S.). ebohula11@bwh.harvard.edu.
Circulation
|March 14, 2018
概括
在LDL-C升高的患者中,Evolocumab有效降低心血管风险,在基线炎症风险较高 (hsCRP) 的患者中观察到更大的绝对风险降低. 这项研究强调了降低LDL- C和炎症标志物的好处,以获得最佳的心血管结果.
科学领域:
- 心血管医学
- 药理学
- 生物化学
背景情况:
- 在FOURIER试验中,PCSK9抑制剂evolocumab在降低LDL- C和心血管风险方面表现出有效性.
- 在此之前,hsCRP指出的基线炎症风险对evolocumab的疗效的影响尚不清楚.
- 这项研究调查了基线hsCRP水平是否会改变evolocumab对心血管的益处.
研究的目的:
- 通过基线高灵敏性C反应蛋白 (hsCRP) 水平分层探索evolcumab的疗效.
- 在LDL-C度中评估炎症和残留胆固醇风险的综合重要性.
- 分析基线hsCRP,LDL- C和心血管结果之间的关联.
主要方法:
- 27,564名患有稳定的动脉样性心血管疾病和升高的LDL- C,接受他类药物治疗的患者被随机分配给evolocumab或安慰剂.
- 在初始hsCRP层 (<1, 1-3, >3 mg/ dL) 中对主要心血管终点进行了有效性比较.
- 多变量模型评估了LDL- C和hsCRP与心血管风险的独立关联.
主要成果:
- 在安慰剂组中,较高的hsCRP基线与显著更高的心血管事件率有关.
- 在所有hsCRP层中,Evolocumab始终降低了心血管风险,相对降低风险也相似.
- 在基线hsCRP水平较高的患者中,evolocumab的绝对风险降低更大.
- 无论是LDL- C还是hsCRP,都与心血管结果独立相关.
结论:
- 无论基线炎症风险如何,Evolocumab可以降低心血管事件,在高hsCRP的患者中,绝对效果更强.
- 通过降低LDL- C,特别是炎症标志物升高的患者,可以实现最佳的心血管风险降低.
- 在hsCRP和LDL- C水平最低的患者中观察到最低的事件率.
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