Effect of Alirocumab on Lipoprotein(a) and Cardiovascular Risk After Acute Coronary Syndrome
Bittner, Vera A. (University of Alabama at Birmingham)
Szarek, Michael (State University of New York)
Aylward, Philip (South Australian Health and Medical Research Institute)
Bhatt, Deepak L. (righam and Women's Hospital (Boston, Estats Units d'Amèrica))
Díaz, Rafaël J. (Instituto Cardiovascular de Rosario)
Edelberg, Jay M. (Sanofi)
Fras, Zlatko (Univerza V Ljubljani)
Goodman, Shaun G. (University of Toronto)
Halvorsen, Sigrun (University of Oslo)
Hanotin, Corinne (Sanofi)
Harrington, Robert A. (Stanford University)
Jukema, J. Wouter (Leiden University Medical Center)
Loizeau, Virginie (Sanofi)
Moriarty, Patrick Maurice (University of Kansas Medical Center)
Moryusef, Angèle (Sanofi)
Pordy, Robert (Regeneron Pharmaceuticals Inc.)
Roe, Matthew T. (Duke University School of Medicine)
Sinnaeve, Peter (University of Leuven)
Tsimikas, Sotirios (University of California San Diego)
Vogel, Robert A. (University of Colorado School of Medicine)
White, Harvey D. (Green Lane Cardiovascular Services Auckland City Hospital)
Zahger, Doron (Soroka University Medical Center)
Zeiher, Andreas Michael (Goethe University)
Steg, Philippe Gabriel (Royal Brompton Hospital (Londres))
Schwartz, Gregory G. (University of Colorado School of Medicine)
Matas Pericas, Laia (Institut d'Investigació Biomèdica Sant Pau)
Gusi Tragant, Gabriel (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Coca Payeras, Antonio (Hospital Clínic i Provincial de Barcelona)
Cequier, Ángel (Hospital Universitari de Bellvitge)
García-Dorado, David (Hospital Universitari Vall d'Hebron)
Bruguera Cortada, Jordi (Hospital del Mar (Barcelona, Catalunya))
Universitat Autònoma de Barcelona

Fecha:	2020
Resumen:	Lipoprotein(a) concentration is associated with cardiovascular events. Alirocumab, a proprotein convertase subtilisin/kexin type 9 inhibitor, lowers lipoprotein(a) and low-density lipoprotein cholesterol (LDL-C). A pre-specified analysis of the placebo-controlled ODYSSEY Outcomes trial in patients with recent acute coronary syndrome (ACS) determined whether alirocumab-induced changes in lipoprotein(a) and LDL-C independently predicted major adverse cardiovascular events (MACE). One to 12 months after ACS, 18,924 patients on high-intensity statin therapy were randomized to alirocumab or placebo and followed for 2. 8 years (median). Lipoprotein(a) was measured at randomization and 4 and 12 months thereafter. The primary MACE outcome was coronary heart disease death, nonfatal myocardial infarction, ischemic stroke, or hospitalization for unstable angina. Baseline lipoprotein(a) levels (median: 21. 2 mg/dl; interquartile range [IQR]: 6. 7 to 59. 6 mg/dl) and LDL-C [corrected for cholesterol content in lipoprotein(a)] predicted MACE. Alirocumab reduced lipoprotein(a) by 5. 0 mg/dl (IQR: 0 to 13. 5 mg/dl), corrected LDL-C by 51. 1 mg/dl (IQR: 33. 7 to 67. 2 mg/dl), and reduced the risk of MACE (hazard ratio [HR]: 0. 85; 95% confidence interval [CI]: 0. 78 to 0. 93). Alirocumab-induced reductions of lipoprotein(a) and corrected LDL-C independently predicted lower risk of MACE, after adjustment for baseline concentrations of both lipoproteins and demographic and clinical characteristics. A 1-mg/dl reduction in lipoprotein(a) with alirocumab was associated with a HR of 0. 994 (95% CI: 0. 990 to 0. 999; p = 0. 0081). Baseline lipoprotein(a) and corrected LDL-C levels and their reductions by alirocumab predicted the risk of MACE after recent ACS. Lipoprotein(a) lowering by alirocumab is an independent contributor to MACE reduction, which suggests that lipoprotein(a) should be an independent treatment target after ACS. (ODYSSEY Outcomes: Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab; NCT01663402).
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	Acute coronary syndromes ; Alirocumab ; Low-density lipoprotein cholesterol ; Major adverse cardiovascular events ; Proprotein convertase subtilisin/kexin type 9 inhibition
Publicado en:	Journal of the American College of Cardiology, Vol. 75 Núm. 2 (21 2020) , p. 133-144, ISSN 1558-3597

DOI: 10.1016/j.jacc.2019.10.057
PMID: 31948641

12 p, 648.4 KB

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