Effect of alirocumab on cardiovascular outcomes after acute coronary syndromes according to age: an ODYSSEY OUTCOMES trial analysis

被引:58
作者
Sinnaeve, Peter R. [1 ]
Schwartz, Gregory G. [2 ]
Wojdyla, Daniel M. [3 ]
Alings, Marco [4 ]
Bhatt, Deepak L. [5 ,6 ]
Bittner, Vera A. [7 ]
Chiang, Chern-En [8 ,9 ,10 ]
Flores, Roger M. Correa [11 ]
Diaz, Rafael [12 ]
Dorobantu, Maria [13 ]
Goodman, Shaun G. [14 ,15 ]
Jukema, J. Wouter [16 ]
Kim, Yong-Un [17 ]
Pordy, Robert [18 ]
Roe, Matthew T. [3 ]
Sy, Rody G. [19 ]
Szarek, Michael [20 ]
White, Harvey D. [21 ]
Zeiher, Andreas M. [22 ]
Steg, Ph Gabriel [23 ,24 ]
机构
[1] Univ Hosp Leuven, Dept Cardiovasc Med, Herestr 49, B-3000 Leuven, Belgium
[2] Univ Colorado, Div Cardiol, Sch Med, Box B130, Aurora, CO 80045 USA
[3] Duke Univ, Duke Clin Res Inst, Div Cardiol, Med Ctr, 200 Morris St, Durham, NC 27701 USA
[4] Amphia Ziekenhuis Molengracht, Dept Cardiol, NL-4818 CK Breda, Netherlands
[5] Brigham & Womens Hosp, Dept Med, Heart & Vasc Ctr, 75 Francis St, Boston, MA 02115 USA
[6] Harvard Med Sch, 75 Francis St, Boston, MA 02115 USA
[7] Univ Alabama Birmingham, Div Cardiovasc Dis, Birmingham, AL 35294 USA
[8] Taipei Vet Gen Hosp, Gen Clin Res Ctr, Shih Pai Rd, Taipei 11217, Taiwan
[9] Taipei Vet Gen Hosp, Div Cardiol, Shih Pai Rd, Taipei 11217, Taiwan
[10] Natl Yang Ming Univ, Shih Pai Rd, Taipei 11217, Taiwan
[11] ESSALUD, Cardiol, Alberto Sabogal Sologuren, Dept Internal Med, Jiron Colina 1081, Peru
[12] Inst Cardiovasc Rosario, Cardiol Dept, Paraguay 160, RA-2000 Rosario, Santa Fe, Argentina
[13] Emergency Clin Hosp Bucharest, Cardiol Dept, 8 Calea Floreasca,ET 6, Bucharest 014461, Romania
[14] Univ Alberta, Canadian VIGOUR Ctr, 87 Ave NW, Edmonton, AB T6G 2E1, Canada
[15] Univ Toronto, St Michaels Hosp, Div Cardiol, 30 Bond St, Toronto, ON M5B 1W8, Canada
[16] Leiden Univ, Dept Cardiol, Med Ctr, POB 9600, NL-2300 RC Leiden, Netherlands
[17] Sanofi, R&D Clin Dev, 1 Ave Pierre Brossolette, F-91380 Chilly Mazarin, France
[18] Regeneron Pharmaceut Inc, Clin Sci Cardiovasc & Metab Therapeut, 777 Old Saw Mill River Rd, Tarrytown, NY 10591 USA
[19] Cardinal Santos Med Ctr, Cardiovasc Inst, Wilson St, San Juan 1502, Metro Manila, Philippines
[20] SUNY, Downstate Sch Publ Hlth, 450 Clarkson Ave, Brooklyn, NY 11203 USA
[21] Auckland 20 City Hosp, Green Lane Cardiovasc Serv, Auckland, New Zealand
[22] Goethe Univ, Dept Med 3, Frankfurt, Germany
[23] Univ Paris, Hop Bichat, AP HP, FACT French Alliance Cardiovasc Trials,INSERM,U11, Paris, France
[24] Imperial Coll, Royal Brompton Hosp, Natl Heart & Lung Inst, London, England
关键词
Acute coronary syndrome; Alirocumab; Low-density lipoprotein cholesterol; Age;
D O I
10.1093/eurheartj/ehz809
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Aims Lowering low-density lipoprotein cholesterol (LDL-C) reduces cardiovascular risk irrespective of age, but the evidence is less strong for older patients. Methods and results This prespecified analysis from ODYSSEY OUTCOMES compared the effect of alirocumab vs. placebo in 18 924 patients with recent acute coronary syndrome (ACS) according to age. We examined the effect of assigned treatment on occurrence of the primary study outcome, a composite of coronary heart disease death, myocardial infarction, ischaemic stroke, or unstable angina requiring hospitalization [major adverse cardiovascular event (MACE)] and all-cause death. Relative risk reductions were consistent for patients >= 65 vs. <65 years for MACE [hazard ratio (HR) 0.78, 95% confidence interval (CI) 0.68-0.91 vs. 0.89, 0.80-1.00; P-interaction = 0.19] and all-cause death [HR 0.77, 0.62-0.95 vs. 0.94, 0.77-1.15; P-interaction = 0.46], and consistent for MACE when dichotomizing at age 75 years (HR 0.85, 0.64-1.13 in >= 75 vs. 0.85, 0.78-0.93 in <75, P-interaction = 0.19). When considering age as a continuous variable in regression models, advancing age increased risk of MACE, as well as the absolute reduction in MACE with alirocumab, with numbers-needed-to-treat for MACE at 3 years of 43 (25-186) at age 45 years, 26 (15-97) at age 75 years, and 12 (6-81) for those at age 85 years. Although adverse events were more frequent in older patients, there were no differences between alirocumab and placebo. Conclusion In patients with recent ACS, alirocumab improves outcomes irrespective of age. Increasing absolute benefit but not harm with advancing age suggests that LDL-C lowering is an important preventive intervention for older patients after ACS.
引用
收藏
页码:2248 / 2258
页数:11
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