脂蛋白(a)与阿利库单抗患者冠状动脉粥样硬化变化的关系

IF 6.5 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Circulation: Cardiovascular Imaging Pub Date : 2024-11-01 Epub Date: 2024-11-19 DOI:10.1161/CIRCIMAGING.124.016683
Konstantinos C Koskinas, Jonas Häner, Yasushi Ueki, Tatsuhiko Otsuka, Jacob Lonborg, Hiroki Shibutani, Ryota Kakizaki, Christoph Kaiser, Robert-Jan van Geuns, Anna S Ondracek, Fabien Praz, Maria Ambühl, David Spirk, Jonas Lanz, Joost Daemen, Dik Heg, Manuel Mayr, François Mach, Stephan Windecker, Thomas Engstrøm, Irene M Lang, Arnold von Eckardstein, Sylvain Losdat, Lorenz Räber
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引用次数: 0

摘要

背景:脂蛋白(a)升高是动脉粥样硬化性疾病的风险标志物,但其潜在机制仍然难以捉摸。我们研究了 Lp(a)与强化降脂治疗后冠状动脉粥样硬化变化的关系:在 PACMAN-AMI 试验(PCSK9 抗体阿利昔单抗对急性心肌梗死患者冠状动脉粥样硬化的影响)中,300 名急性心肌梗死患者被随机分配接受每两周一次的阿利昔单抗 150 毫克或安慰剂治疗,同时服用高强度他汀类药物。患者在基线和52周后接受了连续的双血管血管内超声、光学相干断层扫描和非梗死相关动脉的近红外光谱检查。主要终点是血管内超声显示的粥样斑块体积百分比、光学相干断层扫描显示的最小纤维帽厚度和近红外光谱显示的4毫米内最大脂质核心负荷指数(maxLCBI4mm):共有 265 名患者获得了连续的血管内超声数据(平均年龄为 58±9 岁;16% 为女性)。与安慰剂相比,阿利库单抗可使动脉粥样斑块体积百分比和最大LCBI4mm减少更多,并使最小纤维帽厚度增加更多。在阿利珠单抗组,基线脂蛋白(a)较高的患者(定义为最高四分位数(Q4,≥98 nmol/L;n=30))的最大LCBI4mm减少量小于基线脂蛋白(a)较低的患者(Q1-Q3,调整临床相关基线变量后,P=0.01),与安慰剂组的最大LBI4mm减少量相当(-37.60 [-57.40 to -17.80];n=134)。当基线脂蛋白(a)的临界值为≥75时,上述结果与结论一致:在急性心肌梗死患者中,尽管阿利珠单抗加高强度他汀强化治疗,但基线脂蛋白(a)升高与斑块脂质消退减弱有关。这一发现可能解释了在血脂水平得到最佳控制的情况下,高脂蛋白(a)仍有残留心血管风险的原因:URL:https://www.clinicaltrials.gov;唯一标识符:NCT03067844。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Association of Lipoprotein(a) With Changes in Coronary Atherosclerosis in Patients Treated With Alirocumab.

Background: Elevated Lp(a) (lipoprotein[a]) is a risk marker for atherosclerotic disease, but the underlying mechanisms remain elusive. We examined the association of Lp(a) with changes in coronary atherosclerosis following intensive lipid-lowering therapy.

Methods: In the PACMAN-AMI trial (Effects of the PCSK9 Antibody Alirocumab on Coronary Atherosclerosis in Patients With Acute Myocardial Infarction), 300 patients with acute myocardial infarction were randomized to receive biweekly alirocumab 150 mg or placebo in addition to high-intensity statins. Patients underwent serial 2-vessel intravascular ultrasound, optical coherence tomography, and near-infrared spectroscopy in the non-infarct-related arteries at baseline and after 52 weeks. The main end points were percent atheroma volume by intravascular ultrasound, minimum fibrous cap thickness by optical coherence tomography, and maximum lipid core burden index within 4 mm (maxLCBI4mm) by near-infrared spectroscopy.

Results: A total of 265 patients had serial intravascular ultrasound data (mean age, 58±9 years; 16% women). Alirocumab resulted in greater reductions in percent atheroma volume and maxLCBI4mm, as well as a greater increase in minimum fibrous cap thickness, compared with placebo. In the alirocumab group, the reduction in maxLCBI4mm was smaller in patients with higher baseline Lp(a), defined by the highest quartile (Q4, ≥98 nmol/L; n=30), than in those with lower baseline Lp(a) (Q1-Q3, <98 nmol/L; n=99; -40.2 [-91.1 to 10.7] versus -91.4 [-113.9 to -68.9], respectively; P=0.01 after adjustment for clinically relevant baseline variables), and was comparable to the maxLBI4mm reduction in the placebo group (-37.60 [-57.40 to -17.80]; n=134). These findings were consistent when higher baseline Lp(a) was defined by cut-off values of ≥75 versus <75 nmol/L (n=35 versus 94, respectively, in the alirocumab group) and ≥125 versus <125 nmol/L (n=23 versus 106, respectively). Changes in percent atheroma volume and minimum fibrous cap thickness did not differ in relation to baseline Lp(a).

Conclusions: In patients with acute myocardial infarction, elevated Lp(a) at baseline is associated with attenuation of plaque lipid regression despite intensive treatment with alirocumab plus high-intensity statin. This finding may explain the residual cardiovascular risk associated with high Lp(a) despite optimal control of lipid levels.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03067844.

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来源期刊
CiteScore
6.30
自引率
2.70%
发文量
225
审稿时长
6-12 weeks
期刊介绍: Circulation: Cardiovascular Imaging, an American Heart Association journal, publishes high-quality, patient-centric articles focusing on observational studies, clinical trials, and advances in applied (translational) research. The journal features innovative, multimodality approaches to the diagnosis and risk stratification of cardiovascular disease. Modalities covered include echocardiography, cardiac computed tomography, cardiac magnetic resonance imaging and spectroscopy, magnetic resonance angiography, cardiac positron emission tomography, noninvasive assessment of vascular and endothelial function, radionuclide imaging, molecular imaging, and others. Article types considered by Circulation: Cardiovascular Imaging include Original Research, Research Letters, Advances in Cardiovascular Imaging, Clinical Implications of Molecular Imaging Research, How to Use Imaging, Translating Novel Imaging Technologies into Clinical Applications, and Cardiovascular Images.
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