Please use this identifier to cite or link to this item:
Title: Lipoprotein(a) and Benefit of PCSK9 Inhibition in Patients With Nominally Controlled LDL Cholesterol
Authors: Schwartz, GG
Szarek, M
Bittner, VA
Diaz, R
Goodman, SG
Jukema, JW
Landmesser, U
López-Jaramillo, P
Manvelian, G
Pordy, R
Scemama, M
Sinnaeve, PR
White, HD
Gabriel Steg, P
Gabriel Steg, PH
Bhatt, DL
Harrington, RA
Zeiher, AM
Tricoci, P
Roe, MT
Mahaffey, KW
Edelberg, JM
Hanotin, C
Lecorps, G
Moryusef, A
Sasiela, WJ
Tamby, JF
Aylward, PE
Drexel, H
Sinnaeve, P
Dilic, M
Lopes, RD
Gotcheva, NN
Prieto, JC
Yong, H
Pećin, I
Reiner, Z
Ostadal, P
Poulsen, SH
Viigimaa, M
Nieminen, MS
Danchin, N
Chumburidze, V
Marx, N
Liberopoulos, E
Montenegro Valdovinos, PC
Tse, HF
Kiss, RG
Xavier, D
Zahger, D
Valgimigli, M
Kimura, T
Kim, HS
Kim, SH
Erglis, A
Laucevicius, A
Kedev, S
Yusoff, K
Ramos López, GA
Alings, M
Halvorsen, S
Correa Flores, RM
Sy, RG
Budaj, A
Morais, J
Dorobantu, M
Karpov, Y
Ristic, AD
Chua, T
Murin, J
Fras, Z
Dalby, AJ
Tuñón, J
Asita de Silva, H
Hagström, E
Müller, C
Chiang, CE
Sritara, P
Guneri, S
Parkhomenko, A
Ray, KK
Moriarty, PM
Vogel, R
Chaitman, B
Kelsey, SF
Olsson, AG
Rouleau, JL
Simoons, ML
Alexander, K
Meloni, C
Rosenson, R
Sijbrands, EJG
Alexander, JH
Armaganijan, L
Bagai, A
Bahit, MC
Brennan, JM
Clifton, S
DeVore, AD
Deloatch, S
Keywords: PCSK9 inhibitor
acute coronary syndrome
low-density lipoprotein cholesterol
Acute Coronary Syndrome
Antibodies, Monoclonal, Humanized
Cardiovascular Diseases
Cholesterol, LDL
Middle Aged
PCSK9 Inhibitors
Issue Date: 3-Aug-2021
Publisher: Elsevier BV
Citation: Schwartz, GG, Szarek, M, Bittner, VA, Diaz, R, Goodman, SG, Jukema, JW, Landmesser, U, López-Jaramillo, P, Manvelian, G, Pordy, R, Scemama, M, Sinnaeve, PR, White, HD, Gabriel Steg, P, Gabriel Steg, PH, Bhatt, DL, Harrington, RA, Zeiher, AM, Tricoci, P, Roe, MT, Mahaffey, KW, Edelberg, JM, Hanotin, C, Lecorps, G, Moryusef, A, Sasiela, WJ, Tamby, JF, Aylward, PE, Drexel, H, Sinnaeve, P, Dilic, M, Lopes, RD, Gotcheva, NN, Prieto, JC, Yong, H, Pećin, I, Reiner, Z, Ostadal, P, Poulsen, SH, Viigimaa, M, Nieminen, MS, Danchin, N, Chumburidze, V, Marx, N, Liberopoulos, E, Montenegro Valdovinos, PC, Tse, HF, Kiss, RG, Xavier, D, Zahger, D, Valgimigli, M, Kimura, T, Kim, HS, Kim, SH, Erglis, A, Laucevicius, A, Kedev, S, Yusoff, K, Ramos López, GA, Alings, M, Halvorsen, S, Correa Flores, RM, Sy, RG, Budaj, A, Morais, J, Dorobantu, M, Karpov, Y, Ristic, AD, Chua, T, Murin, J, Fras, Z, Dalby, AJ, Tuñón, J, Asita de Silva, H, Hagström, E, Müller, C, Chiang, CE, Sritara, P, Guneri, S, Parkhomenko, A, Ray, KK, Moriarty, PM, Vogel, R, Chaitman, B, Kelsey, SF, Olsson, AG, Rouleau, JL, Simoons, ML, Alexander, K, Meloni, C, Rosenson, R, Sijbrands, EJG, Alexander, JH, Armaganijan, L, Bagai, A, Bahit, MC, Brennan, JM, Clifton, S, DeVore, AD, Deloatch, S (2021-08-03). Lipoprotein(a) and Benefit of PCSK9 Inhibition in Patients With Nominally Controlled LDL Cholesterol. Journal of the American College of Cardiology 78 (5) : 421-433. ScholarBank@NUS Repository.
Abstract: Background: Guidelines recommend nonstatin lipid-lowering agents in patients at very high risk for major adverse cardiovascular events (MACE) if low-density lipoprotein cholesterol (LDL-C) remains ≥70 mg/dL on maximum tolerated statin treatment. It is uncertain if this approach benefits patients with LDL-C near 70 mg/dL. Lipoprotein(a) levels may influence residual risk. Objectives: In a post hoc analysis of the ODYSSEY Outcomes (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab) trial, the authors evaluated the benefit of adding the proprotein subtilisin/kexin type 9 inhibitor alirocumab to optimized statin treatment in patients with LDL-C levels near 70 mg/dL. Effects were evaluated according to concurrent lipoprotein(a) levels. Methods: ODYSSEY Outcomes compared alirocumab with placebo in 18,924 patients with recent acute coronary syndromes receiving optimized statin treatment. In 4,351 patients (23.0%), screening or randomization LDL-C was <70 mg/dL (median 69.4 mg/dL; interquartile range: 64.3-74.0 mg/dL); in 14,573 patients (77.0%), both determinations were ≥70 mg/dL (median 94.0 mg/dL; interquartile range: 83.2-111.0 mg/dL). Results: In the lower LDL-C subgroup, MACE rates were 4.2 and 3.1 per 100 patient-years among placebo-treated patients with baseline lipoprotein(a) greater than or less than or equal to the median (13.7 mg/dL). Corresponding adjusted treatment hazard ratios were 0.68 (95% confidence interval [CI]: 0.52-0.90) and 1.11 (95% CI: 0.83-1.49), with treatment-lipoprotein(a) interaction on MACE (Pinteraction = 0.017). In the higher LDL-C subgroup, MACE rates were 4.7 and 3.8 per 100 patient-years among placebo-treated patients with lipoprotein(a) >13.7 mg/dL or ≤13.7 mg/dL; corresponding adjusted treatment hazard ratios were 0.82 (95% CI: 0.72-0.92) and 0.89 (95% CI: 0.75-1.06), with Pinteraction = 0.43. Conclusions: In patients with recent acute coronary syndromes and LDL-C near 70 mg/dL on optimized statin therapy, proprotein subtilisin/kexin type 9 inhibition provides incremental clinical benefit only when lipoprotein(a) concentration is at least mildly elevated. (ODYSSEY Outcomes: Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab; NCT01663402)
Source Title: Journal of the American College of Cardiology
ISSN: 0735-1097
DOI: 10.1016/j.jacc.2021.04.102
Appears in Collections:Staff Publications

Show full item record
Files in This Item:
File Description SizeFormatAccess SettingsVersion 
Lipoprotein(a) and Benefit of PCSK9 Inhibition in Patients With Nominally Controlled LDL Cholesterol.pdf1.2 MBAdobe PDF



Google ScholarTM



Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.