PCSK9 and Coronary Artery Plaque-New Opportunity or Red Herring?

IF 5.7 2区医学 Q1 PERIPHERAL VASCULAR DISEASE

Current Atherosclerosis Reports Pub Date : 2024-10-01 Epub Date: 2024-08-16 DOI:10.1007/s11883-024-01230-6

Lucia Barbieri, Gabriele Tumminello, Isabella Fichtner, Alberto Corsini, Raul D Santos, Stefano Carugo, Massimiliano Ruscica

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Abstract

Purpose of review: Although the clinical benefit of reducing low-density lipoprotein cholesterol (LDLc) in patients with coronary artery disease (CAD) is well-established, the impact on plaque composition and stability is less clear. Our narrative review aimed to assess the clinical effects of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors on coronary plaque characteristics specifically focusing from atheroma progression to regression and stabilization.

Recent findings: The combination of statin therapy and PCSK9 inhibitors (evolocumab and alirocumab) promotes plaque stability in patients following an acute coronary syndrome. The GLAGOV study highlighted the relationship between achieved LDLc levels and changes in percentage atheroma volume. Similarly, the PACMAN-AMI study concluded that the qualitative and quantitative changes in coronary plaque were associated with the levels of LDLc. Assessing the severity of coronary artery stenosis and the extent of atherosclerotic burden by means of imaging techniques (e.g., IVUS, OCT and near-infrared spectroscopic) have significantly advanced our understanding of the benefits from promoting plaque regression and achieving to features of plaque stabilization through increasingly intensive lipid-lowering strategies.

Abstract Image

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PCSK9 与冠状动脉斑块--新机遇还是红鲱鱼？

综述目的：尽管降低低密度脂蛋白胆固醇（LDLc）对冠状动脉疾病（CAD）患者的临床益处已得到证实，但其对斑块组成和稳定性的影响却不太明确。我们的叙述性综述旨在评估丙蛋白转化酶亚基酶/kexin 9型（PCSK9）抑制剂对冠状动脉斑块特征的临床影响，特别侧重于从粥样斑块进展到消退和稳定的过程：他汀类药物治疗与 PCSK9 抑制剂（evolocumab 和 alirocumab）联合使用可促进急性冠状动脉综合征患者斑块的稳定。GLAGOV 研究强调了已达到的 LDLc 水平与动脉粥样斑块体积百分比变化之间的关系。同样，PACMAN-AMI 研究也得出结论，冠状动脉斑块的质和量的变化与 LDLc 水平有关。通过成像技术（如 IVUS、OCT 和近红外光谱）评估冠状动脉狭窄的严重程度和动脉粥样硬化的负担范围，极大地促进了我们对通过日益强化的降脂策略促进斑块消退和实现斑块稳定特征的益处的理解。

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来源期刊

Current Atherosclerosis Reports 医学-

CiteScore

9.00

自引率

3.40%

发文量

审稿时长

6-12 weeks

期刊介绍： The aim of this journal is to systematically provide expert views on current basic science and clinical advances in the field of atherosclerosis and highlight the most important developments likely to transform the field of cardiovascular prevention, diagnosis, and treatment. We accomplish this aim by appointing major authorities to serve as Section Editors who select leading experts from around the world to provide definitive reviews on key topics and papers published in the past year. We also provide supplementary reviews and commentaries from well-known figures in the field. An Editorial Board of internationally diverse members suggests topics of special interest to their country/region and ensures that topics are current and include emerging research.