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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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