动脉粥样硬化性心血管疾病患者三重降脂治疗与双重降脂治疗的心血管结局比较

IF 3.6 3区医学 Q2 PHARMACOLOGY & PHARMACY

Journal of clinical lipidology Pub Date : 2025-05-01 DOI:10.1016/j.jacl.2025.04.026

M Kenan Rahima MD, Fernando faxas MD, Muayad Alzamara MD, Godbless Ajenaghughrure MD

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引用次数: 0

摘要

背景/概要ASCVD患者的最佳降脂策略仍存在争议。虽然他汀类药物和依折麦布是已确立的治疗方法，但evolocumab在现实环境中的额外益处还需要进一步研究。目的/目的：利用来自多个医疗机构的真实数据，评估三联降脂治疗（他汀、依折麦贝和evolocumab）与双联治疗（他汀和依折麦贝）在LDL-C水平≥70 mg/dL的动脉粥样硬化性心血管疾病（ASCVD）患者中的有效性和临床结果。方法使用TriNetX全球联邦健康研究网络，包括104个医疗保健组织，我们进行了一项回顾性队列研究，比较倾向评分匹配后三联治疗（n= 10429）和双治疗（n= 10429）的患者。所有患者均有ASCVD，且LDL-C≥70 mg/dL。主要结局包括5年随访期间的死亡、心血管事件和神经系统结局。结果倾向评分匹配后，基线特征包括高血压（89.8% vs 89.8%）、糖尿病（47.4% vs 47.5%）和既往心肌梗死（40.2% vs 40.2%）在组间平衡良好。与双重治疗相比，三联治疗组在多个结局中的风险显著降低：全因死亡率（HR 0.562, 95% CI 0.506-0.624）、痴呆（HR 0.553, 95% CI 0.47 -0.650）、中风（HR 0.683, 95% CI 0.572-0.816）和房颤（HR 0.829, 95% CI 0.773-0.890）。心力衰竭的风险适度降低（HR 0.946, 95% CI 0.900-0.995），而急性心肌梗死和室性心动过速组间无显著差异。结论：在这项针对ASCVD患者的大型现实世界研究中，与双重治疗相比，三重降脂治疗与死亡率和主要心血管结局的风险显著降低相关。这些发现支持对需要额外降脂的高危ASCVD患者考虑三联疗法。

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Comparative cardiovascular outcomes of triple lipid-lowering therapy versus double therapy in patients with atherosclerotic cardiovascular disease: A

Background/Synopsis

The optimal lipid-lowering strategy for patients with ASCVD remains debated. While statins and ezetimibe are established therapies, the additional benefit of evolocumab in real-world settings needs further investigation.

Objective/Purpose

To evaluate the effectiveness and clinical outcomes of triple lipid-lowering therapy (statin, ezetimibe, and evolocumab) compared to double therapy (statin and ezetimibe) in patients with atherosclerotic cardiovascular disease (ASCVD) who have LDL-C levels ≥ 70 mg/dL, using real-world data from multiple healthcare organizations.

Methods

Using the TriNetX global federated health research network comprising 104 healthcare organizations, we conducted a retrospective cohort study comparing patients on triple therapy (n=10,429) versus double therapy (n=10,429) after propensity score matching. All patients had established ASCVD and LDL-C ≥ 70 mg/dL. The primary outcomes included death, cardiovascular events, and neurological outcomes over a 5-year follow-up period.

Results

After propensity score matching, baseline characteristics including hypertension (89.8% vs 89.8%), diabetes (47.4% vs 47.5%), and prior myocardial infarction (40.2% vs 40.2%) were well-balanced between groups. The triple therapy group showed significantly lower risks across multiple outcomes compared to double therapy: all-cause mortality (HR 0.562, 95% CI 0.506-0.624), dementia (HR 0.553, 95% CI 0.470-0.650), stroke (HR 0.683, 95% CI 0.572-0.816), and atrial fibrillation (HR 0.829, 95% CI 0.773-0.890). Heart failure showed modest risk reduction (HR 0.946, 95% CI 0.900-0.995), while acute MI and ventricular tachycardia showed no significant differences between groups.

Conclusions

In this large real-world study of ASCVD patients, triple lipid-lowering therapy was associated with significantly lower risks of mortality and major cardiovascular outcomes compared to double therapy. These findings support the consideration of triple therapy in high-risk patients with ASCVD who require additional lipid lowering.

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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.