Novel Low-Density Lipoprotein Cholesterol Reduction Therapies for the Secondary Prevention of Cardiovascular Disease

被引:0
|
作者
Wang, Xing [1 ]
Wen, Dingke [1 ]
Fang, Mei [1 ,2 ]
You, Chao [1 ]
Ma, Lu [1 ]
机构
[1] Sichuan Univ, West China Hosp, Dept Neurosurg, Chengdu 610041, Sichuan, Peoples R China
[2] Sichuan Univ, West China Med Sch, Chengdu 610041, Sichuan, Peoples R China
关键词
monoclonal antibody; low-density lipoprotein; proprotein convertase subtilisin/kexin type 9; secondary prevention; bempedoic acid; BEMPEDOIC ACID; HIGH-RISK; EFFICACY; SAFETY; ALIROCUMAB; INHIBITORS; PCSK9;
D O I
10.31083/j.rcm2410286
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: To date, optimal agents for low-density lipoprotein cholesterol (LDL-C) reduction in patients with established atherosclerotic cardiovascular disease are still being explored. Thus, we evaluated the efficiency of novel LDL-C-lowering therapies in the secondary prevention of cardiovascular events. Methods: We included randomized clinical trials (RCTs) that explored the effects of different LDL-C lowering agents including alirocumab, evolocumab, and bempedoic acid in adult patients with cardiovascular disease. Several databases were searched from inception through 2022. The safety endpoint includes new-onset diabetes, serious adverse events, and neurocognitive disorders with at least 1 year of follow-up. The efficacy outcomes included composite adverse cardiovascular outcomes, all-cause death, and cardiovascular death. Results: Seven RCTs comprising 53,106 patients were included in this research. Bempedoic acid ranked first in reducing the risk of new-onset diabetes (risk ratio [RR] 0.72, 95% credible interval [CrI] 0.52-0.99) and risk of the composite cardiovascular outcome (RR 0.75, 95% CrI 0.57-0.99). Meta-regression analysis demonstrated that elevated risk of new-onset diabetes was positively correlated with a significant reduction in LDL-C levels (p = 0.03). All treatment agents were associated with a decreased risk of a composite adverse cardiovascular outcome. Conclusions: The present analysis showed that bempedoic acid ranked first in reducing the risk of a composite cardiovascular outcome. In addition, it ranked first in reducing the risk of new-onset diabetes compared with placebo and evolocumab. Our analysis also suggests that the increased risk of new-onset diabetes might be associated with a reduction in LDL-C levels. Besides, the present analysis found that alirocumab ranked first in decreasing all-cause mortality and cardiovascular mortality.
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页数:11
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