治疗PCSK9抑制和静止剂治疗时的残留炎症风险
Aruna D Pradhan1,2, Aaron W Aday2,3, Lynda M Rose2
1Department of Medicine, Division of Cardiovascular Medicine, VA Boston Healthcare System, West Roxbury Campus, MA (A.D.P.). apradhan@bwh.harvard.edu.
Circulation
|May 3, 2018
概括
静止剂和PCSK9抑制剂治疗显著降低了LDL胆固醇,但hsCRP水平显示的残留炎症风险仍然存在. 在接受两种疗法的患者中,较高的hsCRP水平与心血管事件发生率的增加有关.
科学领域:
- 心脏病学
- 药理学
- 炎症研究
背景情况:
- 结合PCSK9抑制的他类药物治疗有效降低了LDL胆固醇和心血管事件.
- 在接受联合治疗的患者中,通过高灵敏性C反应蛋白 (hsCRP) 测量残留炎症风险的作用尚不清楚.
研究的目的:
- 在接受他类药物治疗和PCSK9抑制剂博科齐祖马布的患者中评估残留炎症风险.
- 评估治疗期间hsCRP水平与心血管事件发生率之间的关联.
主要方法:
- 对来自SPIRE-1和SPIRE-2试验的9738名患者进行了后期分析.
- 患者接受了他类药物治疗加上bococizumab,治疗期间的hsCRP (hsCRPOT) 和LDL- C (LDL- COT) 在14周后进行测量.
- 追踪心血管事件 (心肌梗塞,中风,心血管不稳定,心血管死亡).
主要成果:
- 在14周后,博科齐祖马布显著降低了LDL- C,降低了60. 5%,而hsCRP的变化很小.
- 与hsCRP< sub>OT< 1 mg/ L患者相比,患有较高hsCRP< sub>OT水平 (> 3 mg/ L) 的患者心血管事件的风险显著增加 (HR 1. 62).
- 在hsCRP< sub>OT水平和bococizumab获得的相对风险降低之间没有显著的相互作用.
结论:
- 在接受他类药物和PCSK9抑制治疗的患者中,仍存在由治疗期间hsCRP升高的残留炎症风险.
- 较高的hsCRPOT水平与心血管事件的风险增加有关,即使LDL-C水平有所下降.
- 这些发现表明,在联合治疗的患者中,炎症途径可能独立于LDL- C水平,导致心血管风险.
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