Effects of Alirocumab and Evolocumab on Cardiovascular Mortality and LDL-C: Stratified According to the Baseline LDL-C Levels.

IF 1.9 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Reviews in cardiovascular medicine Pub Date : 2025-04-25 eCollection Date: 2025-04-01 DOI:10.31083/RCM26980

Hui Ma, Wenfang Ma, Yang Liu, Lixing Chen, Peng Ding

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引用次数: 0

Abstract

Background: A meta-analysis was conducted to determine whether the cardiovascular mortality and lipid-lowering effects of alirocumab and evolocumab are influenced by various baseline low-density lipoprotein cholesterol (LDL-C) levels.

Methods: We searched for literature published before June 2023. Eligible randomized controlled trials (RCTs) included adults treated with alirocumab or evolocumab and reported LDL-C changes and cardiovascular deaths. The primary endpoints were cardiovascular mortality and percent changes in LDL-C from baseline.

Results: Forty-one RCTs were included in the meta-analysis. Evolocumab did not significantly affect the outcome of cardiovascular mortality whether the baseline data were greater than 100 mg/dL or less than 100 mg/dL. However, the stratified result showed that alirocumab decreased the risk of cardiovascular mortality in patients with a baseline LDL-C level of ≥100 mg/dL (relative risk (RR) 0.45; 95% CI: 0.22 to 0.92; p = 0.03). In terms of lipid-lowering efficacy, alirocumab (mean difference (MD) -56.62%; 95% CI: -60.70% to -52.54%; p < 0.001) and evolocumab (MD -68.10%; 95% CI: -74.85% to -61.36%; p < 0.001) yielded the highest percentage reduction in LDL-C level when baseline levels were 70-100 mg/dL, while the smallest reduction in alirocumab (MD -37.26%; 95% CI: -44.06% to -30.46%; p < 0.001) and evolocumab (MD -37.55%; 95% CI: -40.47% to -34.63%; p < 0.001) occurred with baseline LDL-C levels of ≥160 mg/dL.

Conclusions: Alirocumab and evolocumab presented a better lipid-lowering effect when the baseline LDL-C levels were <100 mg/dL. Alirocumab was associated with a significant reduction in cardiovascular mortality at baseline LDL-C levels of ≥100 mg/dL. This finding can have significant implications for the development of personalized drug therapy.

The prospero registration: CRD42023446723, https://www.crd.york.ac.uk/PROSPERO/view/CRD42023446723.

查看原文本刊更多论文

Alirocumab和Evolocumab对心血管死亡率和LDL-C的影响：根据基线LDL-C水平分层

背景：进行了一项荟萃分析，以确定alirocumab和evolocumab的心血管死亡率和降脂作用是否受到各种基线低密度脂蛋白胆固醇（LDL-C）水平的影响。方法：检索2023年6月前发表的文献。符合条件的随机对照试验（RCTs）包括接受alirocumab或evolocumab治疗的成人，并报告LDL-C变化和心血管死亡。主要终点是心血管死亡率和LDL-C从基线变化的百分比。结果：41项随机对照试验纳入meta分析。无论基线数据是大于100mg /dL还是小于100mg /dL， Evolocumab都不会显著影响心血管死亡率的结果。然而，分层结果显示，alirocumab降低基线LDL-C水平≥100 mg/dL患者的心血管死亡风险(相对风险（RR） 0.45；95% CI: 0.22 ~ 0.92；P = 0.03)。在降脂功效方面，alirocumab (mean difference (MD) -56.62%；95% CI: -60.70% ~ -52.54%；p < 0.001)和evolocumab (MD -68.10%；95% CI: -74.85%至-61.36%；p < 0.001)基线水平为70-100 mg/dL时LDL-C水平降低百分比最高，而阿利单抗降低百分比最小(MD -37.26%；95% CI: -44.06% ~ -30.46%；p < 0.001)和evolocumab (MD -37.55%；95% CI: -40.47% ~ -34.63%；p < 0.001)发生在基线LDL-C水平≥160 mg/dL时。结论：Alirocumab和evolocumab在基线LDL-C水平为时表现出更好的降脂效果。prospero注册：CRD42023446723， https://www.crd.york.ac.uk/PROSPERO/view/CRD42023446723。

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

Reviews in cardiovascular medicine 医学-心血管系统

CiteScore

2.70

自引率

3.70%

发文量

377

审稿时长

1 months

期刊介绍： RCM is an international, peer-reviewed, open access journal. RCM publishes research articles, review papers and short communications on cardiovascular medicine as well as research on cardiovascular disease. We aim to provide a forum for publishing papers which explore the pathogenesis and promote the progression of cardiac and vascular diseases. We also seek to establish an interdisciplinary platform, focusing on translational issues, to facilitate the advancement of research, clinical treatment and diagnostic procedures. Heart surgery, cardiovascular imaging, risk factors and various clinical cardiac & vascular research will be considered.