PCSK9 Inhibitors: Is the Time Ripe for the "Fast Track" Use Independently on the LDL-C Baseline Values in Acute Coronary Syndrome?

IF 3.1 Q2 PERIPHERAL VASCULAR DISEASE
Alessandro Bellis, Ciro Mauro, Emanuele Barbato, Bruno Trimarco, Carmine Morisco
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Abstract

The low-density lipoprotein cholesterol (LDL-C) lowering decreases the risk to develop major adverse cardiovascular events (MACE) in patients with acute coronary syndrome (ACS). Therefore, the "fast track" use of PCSK9 inhibitors (PCSK9i) has been introduced in ACS patients not achieving LDL-C target (70 mg/dl) despite an ongoing lipid lowering therapy with statin at maximum tolerated dosage plus ezetimibe or stain-naïve (LDL-C > 130 mg/dl). PCSK9i "fast track" use has shown to achieve the regression of "non-culprit" atherosclerotic plaques leading to a further MACE decrease. Interestingly, it has been also hypothesized a role of PCSK9i beyond the LDL-C lowering in ACS. PCSK9i have been demonstrated to decrease the inflammation of atherosclerotic plaques and myocardium, inhibit platelet aggregation, and improve the cardiomyocyte survival against the reperfusion injury. All these findings may positively impact on the prognosis and suggest the PCSK9i use in the acute phase of ACS independently on the baseline LDL-C values.

PCSK9 抑制剂:在急性冠状动脉综合征中独立于低密度脂蛋白胆固醇基线值使用 "快速通道 "的时机成熟了吗?
降低低密度脂蛋白胆固醇(LDL-C)可降低急性冠状动脉综合征(ACS)患者发生主要不良心血管事件(MACE)的风险。因此,PCSK9 抑制剂(PCSK9i)被引入 "快速通道",用于正在接受最大耐受剂量他汀类药物加依折麦布降脂治疗但低密度脂蛋白胆固醇(LDL-C)仍未达标(70 毫克/分升)的 ACS 患者或染色无效患者(LDL-C > 130 毫克/分升)。PCSK9i 的 "快速通道 "使用表明,"非诱因 "动脉粥样硬化斑块可以消退,从而进一步降低 MACE。有趣的是,人们还假设 PCSK9i 在 ACS 中的作用不仅仅是降低低密度脂蛋白胆固醇。研究表明,PCSK9i 能减轻动脉粥样硬化斑块和心肌的炎症反应,抑制血小板聚集,提高心肌细胞在再灌注损伤中的存活率。所有这些发现都可能对预后产生积极影响,并建议在急性心肌梗死急性期使用 PCSK9i,而不受 LDL-C 基线值的影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
5.70
自引率
3.30%
发文量
57
期刊介绍: High Blood Pressure & Cardiovascular Prevention promotes knowledge, update and discussion in the field of hypertension and cardiovascular disease prevention, by providing a regular programme of independent review articles covering key aspects of the management of hypertension and cardiovascular diseases. The journal includes:   Invited ''State of the Art'' reviews.  Expert commentaries on guidelines, major trials, technical advances.Presentation of new intervention trials design.''Pros and Cons'' or round tables on controversial issues.Statements on guidelines from hypertension and cardiovascular scientific societies.Socio-economic issues.Cost/benefit in prevention of cardiovascular diseases.Monitoring of healthcare systems.News and views from the Italian Society of Hypertension (including abstracts).All manuscripts are subject to peer review by international experts. Letters to the editor are welcomed and will be considered for publication.
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