Effect of PCSK9 inhibitors on major cardiac adverse events and lipoprotein-a in patients with coronary heart disease: a meta-analysis.

IF 1.5 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Coronary artery disease Pub Date : 2024-12-02 DOI:10.1097/MCA.0000000000001464

Enze Hu, Macao Wan

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引用次数: 0

Abstract

Background: Lipoprotein(a) [Lp(a)] is an independent risk factor for cardiovascular disease due to its unique apo(a) component and its association with atherosclerosis and thrombogenesis. This meta-analysis was conducted to evaluate the effects of PCSK9 inhibitors on major adverse cardiac events (MACE) and Lp(a) levels in patients with coronary heart disease.

Methods: Randomized controlled trials (RCTs) were systematically searched in PubMed, the Cochrane Library, and other databases. Stata 15.1 software was used for data analysis, and a random- or fixed-effects model was selected based on inter-study heterogeneity. Egger's test was applied to detect publication bias.

Results: A total of 12 RCTs were included, involving 48 116 patients with a mean age of 62 years, comprising 65% males and diverse ethnic backgrounds. The results showed that compared with the control group, PCSK9 inhibitors significantly reduced low-density lipoprotein cholesterol (WMD = -1.24 mmol/L, 95% confidence interval (CI): -1.28 to -1.20), total cholesterol, triglycerides, and Lp(a) levels while increasing high-density lipoprotein cholesterol levels. In terms of safety, there was no increased risk of adverse reactions other than injection site reactions. For MACE, PCSK9 inhibitors significantly reduced the risk of nonfatal myocardial infarction, stroke, and coronary revascularization events (RR = 0.87, 95% CI: 0.84-0.89).

Conclusion: PCSK9 inhibitors not only significantly improve blood lipid profiles and reduce Lp(a) levels but also reduce the risk of MACE in patients with coronary heart disease. Therefore, PCSK9 inhibitors offer an effective and safe treatment option for these patients.

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PCSK9抑制剂对冠心病患者主要心脏不良事件和脂蛋白-a的影响：一项荟萃分析

背景：脂蛋白(a) [Lp(a)]由于其独特的载脂蛋白(a)成分及其与动脉粥样硬化和血栓形成的关联而成为心血管疾病的独立危险因素。本荟萃分析旨在评估PCSK9抑制剂对冠心病患者主要不良心脏事件（MACE）和Lp(a)水平的影响。方法：系统地检索PubMed、Cochrane图书馆和其他数据库中的随机对照试验（RCTs）。采用Stata 15.1软件进行数据分析，基于研究间异质性选择随机效应或固定效应模型。应用Egger检验检测发表偏倚。结果：共纳入12项随机对照试验，共纳入48 116例患者，平均年龄62岁，男性占65%，不同种族背景。结果显示，与对照组相比，PCSK9抑制剂显著降低了低密度脂蛋白胆固醇（WMD = -1.24 mmol/L， 95%可信区间（CI）： -1.28 ~ -1.20）、总胆固醇、甘油三酯和Lp(a)水平，同时提高了高密度脂蛋白胆固醇水平。在安全性方面，除了注射部位反应外，没有增加不良反应的风险。对于MACE， PCSK9抑制剂显著降低了非致死性心肌梗死、卒中和冠状动脉血运重建事件的风险（RR = 0.87, 95% CI: 0.84-0.89）。结论：PCSK9抑制剂不仅能显著改善冠心病患者血脂、降低Lp(a)水平，还能降低冠心病患者发生MACE的风险。因此，PCSK9抑制剂为这些患者提供了一种有效且安全的治疗选择。

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

Coronary artery disease 医学-外周血管病

CiteScore

2.50

自引率

0.00%

发文量

190

审稿时长

6-12 weeks

期刊介绍： Coronary Artery Disease welcomes reports of original research with a clinical emphasis, including observational studies, clinical trials, translational research, novel imaging, pharmacology and interventional approaches as well as advances in laboratory research that contribute to the understanding of coronary artery disease. Each issue of Coronary Artery Disease is divided into four areas of focus: Original Research articles, Review in Depth articles by leading experts in the field, Editorials and Images in Coronary Artery Disease. The Editorials will comment on selected original research published in each issue of Coronary Artery Disease, as well as highlight controversies in coronary artery disease understanding and management. Submitted artcles undergo a preliminary review by the editor. Some articles may be returned to authors without further consideration. Those being considered for publication will undergo further assessment and peer-review by the editors and those invited to do so from a reviewer pool.