Effect of PCSK9 Monoclonal Antibody Versus Placebo/Ezetimibe on Atrial Fibrillation in Patients at High Cardiovascular Risk: A Meta-Analysis of 26 Randomized Controlled Trials

被引:6
作者
Yang, Shuai [1 ]
Shen, Wen [2 ]
Zhang, Hong-Zhou [1 ]
Wang, Chen-Xi [1 ]
Yang, Ping-Ping [3 ]
Wu, Qing-Hua [2 ,4 ]
机构
[1] Nanchang Univ, Clin Med Coll 2, Nanchang, Jiangxi, Peoples R China
[2] Nanchang Univ, Affiliated Hosp 2, Dept Cardiol, Nanchang, Jiangxi, Peoples R China
[3] Nanchang Univ, Affiliated Hosp 2, Dept Endocrinol, Nanchang, Jiangxi, Peoples R China
[4] Nanchang Univ, Affiliated Hosp 2, Cardiovasc Dis Prevent & Treatment Ctr, Nanchang, Jiangxi, Peoples R China
基金
中国国家自然科学基金;
关键词
PCSK9 monoclonal antibody; Ezetimibe; Atrial fibrillation; Meta-analysis; Randomized controlled; SUBTILISIN/KEXIN TYPE 9; REDUCING LIPIDS; STATIN THERAPY; EFFICACY; SAFETY; ALIROCUMAB; EVOLOCUMAB; HYPERCHOLESTEROLEMIA; EPIDEMIOLOGY; PREVENTION;
D O I
10.1007/s10557-022-07338-8
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background Patients at high cardiovascular risk are closely associated with an increased risk of atrial fibrillation (AF). Whether proprotein convertase subtilisin/kexin type 9 monoclonal antibodies (PCSK9 mAbs) can attenuate AF progression remains unknown. Methods To compare PCSK9 mAbs with placebo or ezetimibe to explore the effect of PCSK9 mAbs therapy on the end-point of incidence of AF, we searched PubMed, Embase, and ClinicalTrials.gov for articles. We used Mantel-Haenszel risk ratio (RR) with corresponding 95% CI for the categorical data, including the incidence of AF and predefined other outcomes of interest. Results We included 21 articles consisting of 26 randomized controlled trials with a total of 95,635 participants. Quantitative synthesis revealed that PCSK9 mAbs significantly reduce the incidence of AF events (RR 0.84; 95% CI 0.72-0.98; p = 0.03), whereas no obvious differences were seen between the PCSK9 mAbs group and the ezetimibe group (RR 0.90; 95% CI 0.29-2.76; p = 0.85). PCSK9 mAbs also markedly decreased the incidence of cerebrovascular events (RR 0.75; 95% CI 0.66-0.85; p < 0.0001) and new-onset hypertension (RR 0.92; 95% CI 0.87-0.97; p = 0.003), but not the risk of cardiovascular death (RR 0.95; 95% CI 0.85-1.07; p = 0.40) and new-onset diabetes mellitus (RR 1.01; 95% CI 0.95-1.08; p = 0.67). Conclusions Overall, the PCSK9 mAbs therapy reduced AF and presented certain cardiovascular benefits in patients at high cardiovascular risk. Further big-scale and long follow-up duration randomized controlled trials that compare PCSK9 mAbs with ezetimibe are required to evaluate the effect of PCSK9 mAbs versus ezetimibe on AF.
引用
收藏
页码:927 / 940
页数:14
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