JAHA:PCSK9抑制剂对高胆固醇血症患者临床结局的影响!

2017-12-10 xing.T MedSci原创

由此可见,采用PCSK9抑制剂治疗的耐受性良好,能改善心血管预后。尽管在全因或心血管疾病死亡率方面没有发现总体的益处,但基线较高的低密度脂蛋白胆固醇患者可能获益更多。

近日,心血管疾病领域权威杂志JAHA上发表了一篇荟萃分析文章,研究人员旨在评估2 种PCSK9(前蛋白转化酶枯草溶菌素9)抑制剂:alirocumab与evolocumab的疗效和安全性。

研究人员对比较有无采用PCSK9抑制剂治疗的随机对照试验进行了一项系统回顾和荟萃分析;共纳入了35项随机对照试验,包含45539例患者(平均随访85.5周)。这些受试者平均年龄为61±2.8岁,平均基线低密度脂蛋白胆固醇为106±22mg/dL。与没有采用PCSK9抑制剂治疗相比,采用PCSK9抑制剂治疗与降低心肌梗死(2.3% vs. 3.6%;比值比[OR]为:0.72[95%可信区间(CI)为0.64-0.81];P<0.001)、脑卒中(1% vs. 1.4%;OR为0.80 [95%CI为0.67-0.96];P=0.02)和冠状动脉血运重建术(4.2% vs. 5.8%;OR为0.78 [95%CI为 0.71-0.86];P<0.001)的发生率相关。

总体而言,在全因死亡率(OR为0.71(95%CI为0.47-1.09),P=0.12)或心血管死亡率(OR为1.01(95%CI为0.85-1.19);P=0.95)方面没有显著变化。而较高的基线低密度脂蛋白胆固醇与全因死亡率的获益之间有显著的相关性(P=0.038)。神经认知不良事件(OR为1.12[95%CI为0.88-1.42];P=0.37)、肌痛(OR为0.95[95%CI为0.75-1.20];P=0.65)、新发或加重原有的糖尿病(OR为1.05[95%CI为0.95-1.17];P=0.32)、肌酸激酶水平升高(OR为0.84[95%CI为0.70-1.01];P=0.06)或丙氨酸、天门冬氨酸氨基转移酶水平升高(OR为0.96[95%CI为0.82-1.12];P=0.61)。

由此可见,采用PCSK9抑制剂治疗的耐受性良好,能改善心血管预后。尽管在全因或心血管疾病死亡率方面没有发现总体的益处,但基线较高的低密度脂蛋白胆固醇患者可能获益更多。

原始出处:

Aris Karatasakis, et al. Effect of PCSK9 Inhibitors on Clinical Outcomes in Patients With Hypercholesterolemia: A Meta‐Analysis of 35 Randomized Controlled Trials.JAHA.2017. https://doi.org/10.1161/JAHA.117.006910

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    2018-01-25 Tamikia
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    2018-05-13 FukaiBao
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    2018-09-21 jklm09
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    2017-12-12 zhaohui6731
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    2017-12-11 wzb521zf

    一起学习一下

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