在接受三联降脂治疗的急性冠状动脉综合征患者中，脂蛋白(a)水平升高减缓了LDL-C的降低

IF 3.6 3区医学 Q2 PHARMACOLOGY & PHARMACY

Journal of clinical lipidology Pub Date : 2025-05-01 DOI:10.1016/j.jacl.2025.04.018

Jaibharat Sharma MD, Surender Himral MD, Roshan Thakur MD, Raman Puri MD, Pankaj Chandel, Komal Mohite, Aziz Khan MD, Rajeev Agarwala MD, Vinod Vijan MD, Kunal Mahajan MD

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引用次数: 0

摘要

背景/摘要脂蛋白(a)升高[Lp(a)]被认为是冠状动脉疾病患者不良结局的独立危险因素。急性冠脉综合征（ACS）患者Lp(a)降低的研究正在进行中。ACS的标准治疗包括高强度他汀类药物（HIS），它可以矛盾地增加Lp(a)水平。依折替米贝和PCSK9抑制剂能降低Lp(a)，而苯乙甲酸（BA）的作用最小。在接受积极降脂治疗（LLT）的ACS患者中，关于Lp(a)升高（50 mg/dL或更高）对LDL-C降低的影响的数据有限。目的/目的评价40mg瑞舒伐他汀、依折替米贝和BA （REB方案）治疗的ACS患者Lp(a)水平的变化及其与LDL-C降低反应的关系。方法回顾性分析本中心2023年3月至2024年12月期间接受REB方案治疗的他汀类药物初治ACS患者的数据。仅纳入在ACS入院时和ACS后1个月具有一致LLT和可用Lp(a)和LDL-C水平的患者。我们评估了Lp(a)水平变化的影响，特别是那些超过50 mg/dL的水平，对平均LDL-C降低和达到LDL-C目标的患者百分比的影响。50 mg / dL。结果分析了303例患者的资料。入院时平均LDL-C为111.8±34.6 mg/dL，一个月后降至44.7±15.9 mg/dL（下降60%）。70.3%（213/303）的患者达到LDL-C和lt；一个月50mg /dL。中位Lp(a)从入院时的28.1 mg/dL增加到一个月后的64.6 mg/dL。入院时Lp(a)≥50mg /dL的患病率为28.7%，1个月时为60.4%。Logistic回归分析表明，Lp(a)升高与LDL-C <达标概率降低相关；1个月50 mg/dL[比值比=0.98(0.97-0.99),p<0.01]。入院时Lp(a)升高50 mg/dL或更高的患者，1个月的平均LDL-C达到明显更高(54.3±16.7 vs 40.9±13.8,p <；0.001)和1个月时(48.7±16.1 vs 38.5±13.3,p <；0.001)。结论：在ACS患者接受积极降LDL-C治疗时，Lp(a)水平升高与LDL-C反应减弱相关。在积极降低LDL-C的过程中，Lp(a)的增加可能会阻碍LDL-C的最佳目标。这些发现强调了ACS患者监测Lp(a)的必要性，并表明降低Lp(a)的治疗可能优化心血管风险的降低。需要进一步的研究来评估降低Lp(a)策略对acs后接受积极LDL-C管理的患者的临床影响。

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Elevated lipoprotein(a) levels attenuate LDL-C lowering in acute coronary syndrome patients treated with triple combination lipid-lowering therapy

Background/Synopsis

Elevated lipoprotein(a) [Lp(a)] is recognized as an independent risk factor for adverse outcomes in coronary artery disease patients. Research on Lp(a) reduction in acute coronary syndrome (ACS) is ongoing. The standard of care for ACS includes high-intensity statins (HIS), which can paradoxically increase Lp(a) levels. While ezetimibe and PCSK9 inhibitors reduce Lp(a), bempedoic acid (BA) shows minimal effect. Limited data exist regarding the impact of elevated Lp(a) (50 mg/dL or higher) on LDL-C lowering in ACS patients undergoing aggressive lipid-lowering therapy (LLT).

Objective/Purpose

To evaluate changes in Lp(a) levels and their association with LDL-C lowering response in ACS patients treated with a triple combination of 40 mg rosuvastatin, ezetimibe, and BA (REB regimen).

Methods

We retrospectively analyzed data from statin-naive ACS patients at our center who received the REB regimen between March 2023 and December 2024. Only patients with consistent LLT for one month and available Lp(a) and LDL-C levels at index ACS admission and one-month post-ACS were included. We assessed the impact of changes in Lp(a) levels, particularly those exceeding 50 mg/dL, on mean LDL-C reduction and the percentage of patients achieving the LDL-C target of < 50 mg/dL.

Results

Data from 303 patients were analyzed. Mean LDL-C at admission was 111.8 ± 34.6 mg/dL, decreasing to 44.7 ± 15.9 mg/dL at one month(60% reduction). 70.3% (213/303) of patients achieved LDL-C < 50 mg/dL at one month. Median Lp(a) increased from 28.1 mg/dL at admission to 64.6 mg/dL at one month. The prevalence of Lp(a) 50 mg/dL or higher was 28.7% at admission and 60.4% at one month. Logistic regression analysis indicated that an increase in Lp(a) was associated with a decreased probability of achieving LDL-C < 50 mg/dL at one month [Odds ratio=0.98(0.97-0.99), p<0.01]. The mean LDL-C achieved at one month was significantly higher in patients with elevated Lp(a) 50 mg/dL or higher, both at admission (54.3 ± 16.7 vs 40.9 ± 13.8, p < 0.001) and at one month (48.7 ± 16.1 vs 38.5 ± 13.3, p < 0.001).

Conclusions

In ACS patients treated with aggressive LDL-C lowering therapy, elevated Lp(a) levels are associated with a blunted LDL-C response. The increase in Lp(a) during aggressive LDL-C lowering may hinder optimal LDL-C targets. These findings highlight the need for Lp(a) monitoring in ACS patients and suggest that Lp(a)-lowering therapies may optimize cardiovascular risk reduction. Further research is needed to evaluate the clinical impact of Lp(a)-lowering strategies in patients undergoing aggressive LDL-C management post-ACS.

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来源期刊

Journal of clinical lipidology 医学-药学

CiteScore

7.00

自引率

6.80%

发文量

209

审稿时长

49 days

期刊介绍： Because the scope of clinical lipidology is broad, the topics addressed by the Journal are equally diverse. Typical articles explore lipidology as it is practiced in the treatment setting, recent developments in pharmacological research, reports of treatment and trials, case studies, the impact of lifestyle modification, and similar academic material of interest to the practitioner. Sections of Journal of clinical lipidology will address pioneering studies and the clinicians who conduct them, case studies, ethical standards and conduct, professional guidance such as ATP and NCEP, editorial commentary, letters from readers, National Lipid Association (NLA) news and upcoming event information, as well as abstracts from the NLA annual scientific sessions and the scientific forums held by its chapters, when appropriate.