在老年人中使用Evolocumab的长期脂质降低
Samer Al Said1, Michelle L O'Donoghue1, Xinhui Ran1
1TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Journal of the American College of Cardiology
|February 5, 2025
概括
长期使用埃沃洛库马布 (一种PCSK9抑制剂) 对75岁及以上的患者提供了显著的心血管益处,与年轻人相比. 这项研究表明,在患有动脉样硬化心血管疾病的老年人中,早期启动evolocumab是安全有效的.
科学领域:
- 心脏病学 心脏病学
- 药理学 药理学是指药理学的学科.
- 老年病的医生 老年病的医生
背景情况:
- 由于PCSK9抑制剂的数据有限,美国的指导方针建议对75岁以上的患者进行不那么强烈的LDL胆固醇降低.
- 在老年人中抑制蛋白转化酶亚素/素9型 (PCSK9) 的长期疗效和安全性数据稀少.
研究的目的:
- 评估埃沃洛库马布在75岁及以上患者的长期心血管益处.
- 为了比较evolocumab在老年患者和患有动脉样硬化心血管疾病的年轻患者的疗效和安全性.
主要方法:
- 对FOURIER试验及其开放式扩展 (FOURIER-OLE) 的分析,涉及27,564名动脉样硬化心血管疾病患者.
- 按年龄 (<75岁与≥75岁) 分别对主要复合终点 (心血管死亡,心脏病发作,中风,再血管) 的分层分析,平均随访时间为7.1年.
- 评估跨年龄组和治疗组的安全事件率.
主要成果:
- 在75岁以上的患者中,埃沃洛库马布降低了主要终点,危险比为0.79 (95% CI:0.64-0.97),与年轻患者相似 (HR:0.86).
- 绝对风险降低在老年患者 (5.4%) 与年轻患者 (2.3%) 相比较大,需要治疗的患者数量较少 (19对44).
- 在治疗组和年龄组中,安全事件的年均发病率是可比的.
结论:
- 早期启动长期埃沃洛库马布治疗为患有动脉样硬化心血管疾病的老年患者 (≥75岁) 提供了相当大的心血管益处.
- 埃沃洛库马布在老年人中的疗效和安全性概况与年轻患者的疗效和安全性概况相似,需要治疗的患者数量更为有利.
- 研究结果支持对老年人群考虑使用evolocumab,以减少心血管事件风险.
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