脂蛋白 (a),PCSK9抑制和心血管风险
Michelle L O'Donoghue1, Sergio Fazio2, Robert P Giugliano1
1TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.L.O., R.P.G., E.K., K.A.I., M.S.S.).
较高的脂蛋白水平会增加心血管风险. 作为PCSK9抑制剂的Evolocumab有效降低Lp(a) 的水平,并且在基线Lp(a) 升高的患者中提供更大的冠状动脉益处.
科学领域:
- 心血管医学
- 脂肪学
- 药理学
背景情况:
- 脂蛋白 (Lp) 有关动脉样硬化的发展.
- 可以证明PCSK9抑制剂降低了血Lp (a) 水平.
- 需要进一步定义Lp(a),PCSK9抑制和心血管风险降低之间的相互作用.
研究的目的:
- 评估基线Lp (a) 水平的预后意义.
- 根据基线Lp (a) 度评估埃沃洛库马布降低心血管事件的疗效.
- 确定PCSK9抑制对Lp (a) 水平和相关心血管风险的影响.
主要方法:
- 对来自FOURIER试验的25096名患者的分析 (evolcumab与安慰剂).
- 在基线和48周Lp (a) 的测量.
- 考克斯的比例危险模型来评估Lp (a) 预后值和evolocumab在Lp (a) 层中的有效性.
主要成果:
- 基线Lp (最高四分位数) 的升高独立预测了冠心病风险的升高 (aHR为1.22).
- 在Lp (a) > 中位数的患者中,Evolocumab降低了Lp (a) 26. 9%,并显著降低了冠状动脉风险 (HR 0. 77).
- 患有较高基线Lp (a) 的患者经历了较大的绝对风险降低 (2. 49% vs 0. 95%).
结论:
- 较高的Lp{a}水平是心血管事件的重要独立风险因素.
- 埃沃洛库马布有效降低了Lp (a) 值,并且在基线Lp (a) 值升高的患者中提供了更大的绝对心血管风险降低.
- 抑制PCSK9,特别是使用evolocumab,为高Lp (a) 患者控制心血管风险提供了有前途的治疗策略.
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