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Lipoprotein(a) and Benefit of PCSK9 Inhibition in Patients With Nominally Controlled LDL Cholesterol

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dc.contributor.authorSchwartz, Gregory G.
dc.contributor.authorSzarek, Michael
dc.contributor.authorBittner, Vera A.
dc.contributor.authorDiaz, Rafael
dc.contributor.authorGoodman, Shaun G.
dc.contributor.authorJukema, J. Wouter
dc.contributor.authorLandmesser, Ulf
dc.contributor.authorLópez-Jaramillo, Patricio
dc.contributor.authorManvelian, Garen
dc.contributor.authorPordy, Robert
dc.contributor.authorScemama, Michel
dc.contributor.authorSinnaeve, Peter R.
dc.contributor.authorWhite, Harvey D.
dc.contributor.authorSteg, Gabriel
dc.contributor.authorODYSSEY Outcomes Committees and Investigators
dc.contributor.researchgroupMasiraspa
dc.date.accessioned2022-02-21T14:04:52Z
dc.date.available2022-02-21T14:04:52Z
dc.date.issued2021-08-03
dc.descriptionDigitalspa
dc.description.abstractBackground 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)spa
dc.description.researchareaCiencias Médicas y de la Saludspa
dc.format.extent13 pspa
dc.format.mimetypeapplication/pdfspa
dc.identifier.arkhttps://doi.org/10.1016/j.jacc.2021.04.102
dc.identifier.urihttps://repositorio.udes.edu.co/handle/001/6065
dc.language.isoengspa
dc.publisherElsevierspa
dc.publisher.placeUSAspa
dc.relation.citationendpage433spa
dc.relation.citationissue5spa
dc.relation.citationstartpage421spa
dc.relation.citationvolume78spa
dc.relation.indexedScopusspa
dc.relation.ispartofjournalJournal of the American College of Cardiologyspa
dc.rights© 2021 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.spa
dc.rights.accessrightsinfo:eu-repo/semantics/openAccessspa
dc.rights.creativecommonsAtribución-NoComercial 4.0 Internacional (CC BY-NC 4.0)spa
dc.rights.urihttps://creativecommons.org/licenses/by-nc/4.0/spa
dc.sourcehttps://www.sciencedirect.com/science/article/pii/S0735109721052475?via%3Dihubspa
dc.subject.proposalAcute coronary syndromeeng
dc.subject.proposalLipoprotein(a)eng
dc.subject.proposalLow-density lipoprotein cholesteroleng
dc.subject.proposalPCSK9 inhibitoreng
dc.titleLipoprotein(a) and Benefit of PCSK9 Inhibition in Patients With Nominally Controlled LDL Cholesterolspa
dc.typeArtículo de revistaspa
dc.type.coarhttp://purl.org/coar/resource_type/c_6501spa
dc.type.contentTextspa
dc.type.driverinfo:eu-repo/semantics/articlespa
dc.type.redcolhttp://purl.org/redcol/resource_type/ARTspa
dc.type.versioninfo:eu-repo/semantics/publishedVersionspa
dcterms.audienceTodas las Audienciasspa
dspace.entity.typePublication
oaire.accessrightshttp://purl.org/coar/access_right/c_abf2spa
oaire.versionhttp://purl.org/coar/version/c_970fb48d4fbd8a85spa
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