蛋白转化酶枯草杆菌素/kexin 9型靶向治疗与心律失常风险之间的关系：随机对照试验的荟萃分析

IF 5.9 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American journal of preventive cardiology Pub Date : 2025-09-21 DOI:10.1016/j.ajpc.2025.101311

Vikash Jaiswal , Aman Goyal , Novonil Deb , Nishat Shama , Vivek Mittal , Kripa Rajak , Anupam Halder , Sulochana Khadka , Tushar Kumar , Raheel Ahmed , Ibadete Bytyçi , Maciej Banach , Lipid and Blood Pressure Meta-Analysis Collaboration (LBPMC) Group

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引用次数: 0

摘要

背景：蛋白转化酶枯草杆菌素/凯斯蛋白9型（PCSK9）靶向治疗可有效降低低密度脂蛋白胆固醇（LDL-C）和循环PCSK9水平。然而，它们对心律失常风险的影响仍不确定，本荟萃分析旨在调查其相关性。方法系统检索自启动至2024年8月16日所有电子数据库中相关随机对照试验（rct）的文献。主要临床终点为心房颤动（AFib），次要终点为心房扑动（AFL）、心室颤动（VF）、室性心动过速（VT）、室上心动过速（SVT）、心源性猝死（SCD）、心脏骤停和房室传导阻滞。结果共纳入28项随机对照试验，共95,520例患者。PCSK9抑制剂治疗组的平均年龄与对照组相似（60.13岁vs. 60.06岁）。在平均1.6年的随访中，PCSK9i组与对照组相比，AFib （OR, 0.88; 95% CI: 0.75-1.03, p = 0.11）、AFL （OR, 1.04; 95% CI: 0.70-1.54, p = 0.84）、VT （OR, 0.80; 95% CI: 0.58-1.11, p = 0.18）、VF （OR, 0.77; 95% CI: 0.40-1.47, p = 0.43）和SVT （OR, 0.94; 95% CI: 0.56-1.58, p = 0.82）的风险相似。同样，SCD （OR, 0.91; 95% CI: 0.62-1.32, p = 0.61）和AV阻滞（OR, 0.72; 95% CI: 0.34-1.52, p = 0.39）组间无差异。结论本荟萃分析未发现PCSK9i与心律失常之间存在显著关联。

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Association between proprotein convertase subtilisin/kexin type 9 targeted therapies and the risk of arrhythmias: a meta-analysis of randomized controlled trials

Background

Proprotein convertase subtilisin/kexin type 9 (PCSK9) targeted therapies effectively lower low-density lipoprotein cholesterol (LDL-C) and circulating PCSK9 levels. However, their effect on the risk of arrhythmias remains uncertain, and this meta-analysis aims to investigate the association.

Methods

We performed a systematic literature search on all electronic databases for relevant randomized controlled trials (RCTs) from inception until 16th August 2024. Primary clinical endpoint was atrial fibrillation (AFib), while the secondary endpoints were atrial flutter (AFL), ventricular fibrillation (VF), ventricular tachycardia (VT), supraventricular tachycardia (SVT), sudden cardiac death (SCD), cardiac arrest and atrioventricular blocks.

Results

28 RCTs with 95,520 patients were finally included in the analysis. The mean age of the group treated with PCSK9 inhibitors was similar to the control group (60.13 years vs. 60.06 years). At mean follow-up of 1.6 years the PCSK9i group had similar risk of AFib (OR, 0.88; 95 %CI: 0.75–1.03, p = 0.11), AFL (OR, 1.04; 95 %CI: 0.70–1.54, p = 0.84), VT (OR, 0.80; 95 %CI: 0.58–1.11, p = 0.18), VF (OR, 0.77;95 %CI: 0.40–1.47, p = 0.43) and SVT (OR, 0.94; 95 %CI: 0.56–1.58, p = 0.82) compared to control group. Similarly, the SCD (OR, 0.91; 95 %CI: 0.62–1.32, p = 0.61), and AV block (OR, 0.72; 95 %CI: 0.34–1.52, p = 0.39) did not differ between the groups.