Clinical Observation of PCSK9 Inhibitor in Patients with Acute Coronary Syndrome

2021 ◽  
Vol 11 (12) ◽  
pp. 6045-6053
Author(s):  
秀玲 王
Keyword(s):  
Acute Coronary Syndrome ◽  
Clinical Observation ◽  
Pcsk9 Inhibitor ◽  
Coronary Syndrome

scholarly journals Experience of the use of the PCSK9 inhibitor Alirocumab in patients with extremely high cardiovascular risk

Kardiologiia ◽  
2020 ◽  
Vol 60 (8) ◽  
pp. 71-77
Author(s):  
V. A. Korneva ◽  
T. Yu. Kuznetsova ◽  
I. S. Scopetc ◽  
N. N. Vezikova
Keyword(s):  
Acute Coronary Syndrome ◽  
Cardiovascular Risk ◽  
Cerebrovascular Disease ◽  
Laboratory Data ◽  
Myocardial Revascularization ◽  
Real Life ◽  
Transient Ischemic Attacks ◽  
High Cardiovascular Risk ◽  
Pcsk9 Inhibitor ◽  
Coronary Syndrome

Aim To study the efficacy and safety of alirocumab in patients with high and very high cardiovascular risk in the Republic of Karelia and to evaluate their compliance with the alirocumab therapy.Materials and methods Study design: observational, noncomparative. The observation group consisted of 9 patients receiving alirocumab (Praluent®) (mean age, 48.6±4.7 years; 7 men). 7 patients had familial hypercholesterolemia of the type diagnosed by DLCN criteria; five patients had MI. Lipid profile, concentrations of transaminases, creatinine, glucose, and lipoprotein a (LP(a)) were measured at 3, 6, 12, and 18 months. Electrocardiography was performed, and the clinical picture (development of acute coronary syndrome, acute cerebrovascular disease, transient ischemic attacks, myocardial revascularization, and cardiovascular death) was evaluated. Efficacy criteria included the absence of these clinical conditions, the proportion of patients who achieved the LDL CS goal, and the decrease in LP(a). Safety was evaluated by clinical and laboratory data, such as levels of transaminases, total bilirubin, creatinine, and blood glucose. The observation lasted for 6 months to 1.5 years.Results LDL CS goals were achieved in 7 (77.8%) patients receiving alirocumab. The mean level of LP(a) decreased from 0.39 to 0.28 g/l; the degree of decrease ranged from 20 to 33 %. No cases of IHD instability (acute coronary syndrome) or new cases of acute cerebrovascular disease and transient ischemic attacks were observed. None of the patients had to stop the alirocumab treatment; adverse effects, including local ones, were not observed.Conclusion LDL CS goals were achieved in 7 (77.8%) patients. The level of LP(a) decreased by 20-33% in patients receiving the PCSK9 inhibitor. In real-life clinical practice, the alirocumab treatment was characterized with high compliance and good tolerability without side effects, including local ones.

scholarly journals PCSK9 inhibitors for in-hospital treatment of patients with acute coronary syndrome and severe lipid metabolism disorders

2020 ◽  
Vol 25 (8) ◽  
pp. 4010
Author(s):  
O. L. Barbarash ◽  
N. V. Fedorova ◽  
D. Yu. Sedykh ◽  
O. V. Gruzdeva ◽  
O. N. Khryachkova ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Statin Therapy ◽  
Lipid Lowering ◽  
High Density Lipoproteins ◽  
Hospital Treatment ◽  
Lipid Lowering Therapy ◽  
Pcsk9 Inhibitor ◽  
Coronary Syndrome ◽  
Lowering Therapy ◽  
Baseline Values

Aim. To assess the efficacy and safety of PCSK9 inhibitor alirocumab as part of a combination lipid-lowering therapy in patients with acute coronary syndrome (ACS).Material and methods. This prospective, open-label, single-center activetreatment study included 13 patients hospitalized due to ACS. The main inclusion criterion was nonachievement of target low-density lipoprotein cholesterol (LDL-C) values (<1,4 mmol/L) with high-intensity statin therapy prior to ACS. During the first 30 days after ACS, all patients received therapy with atorvastatin 40-80 mg/day or rosuvastatin 20-40 mg/day in combination with alirocumab 150 mg/ml (Praluent) administered by subcutaneous injection. Lipid and biochemical profiles were monitored. The first injection of the PCSK9 inhibitor was performed on days 3-5 of hospitalization, the second — after 2 weeks.Results. On admission, the median LDL-C was 4,3 [3,5;5,3] mmol/L. A day after administration, there was a decrease in LDL-C by 41,9% (median 2,5 [1,8;3,2] mmol/L; p=0,001) without a negative effect on high-density lipoproteins (HDL-C) (median 1,2 [0,8;1,4] mmol/L; p=0,270). Before the next injection, LDL-C decreased by another 8% (median 2,3 [1,1;4,1] mmol/L). A day after the second injection, a decrease in LDL-C from the baseline values was 69,8% (median 1,3 [0,7;1,5] mmol/L; p=0,010). Strengthening lipid-lowering therapy with a PCSK9 inhibitor within 30 days after ACS did not lead to clinical and biochemical deterioration.Conclusion. The use of subcutaneous 150-mg injections of alirocumab 2 times a week 30 days after ACS in patients who did not reach target LDL-C values with statin therapy, leads to a 69% decrease in LDL-C from baseline values and is safe.

scholarly journals The case of takotsubo syndrome

2021 ◽  
Vol 37 (6) ◽  
pp. 123-130
Author(s):  
Ya. B. Khovaeva ◽  
N. V. Kiryanova ◽  
T. M. Zinkovskaya ◽  
N. V. Ivanova ◽  
D. Yu. Sosnin ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Differential Diagnosis ◽  
Cardiac Dysfunction ◽  
Clinical Observation ◽  
Current Understanding ◽  
Takotsubo Syndrome ◽  
Atypical Form ◽  
Coronary Syndrome

The article describes the current understanding of the takotsubo syndrome concerning the issues of pathogenesis, differential diagnosis with acute coronary syndrome and strategy of management. There is presented our own clinical observation of a patient with an atypical form of cardiac dysfunction and myocardial geometry.

scholarly journals LIPID TESTING, LIPID MODIFYING THERAPY AND PCSK9 INHIBITOR ELIGIBILITY IN 22,603 PATIENTS WITH INCIDENT ACUTE CORONARY SYNDROME

2020 ◽  
Vol 75 (11) ◽  
pp. 172
Author(s):  
Bradley Sarak ◽  
Anamaria Savu ◽  
Padma Kaul ◽  
Finlay McAlister ◽  
Robert Welsh ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Pcsk9 Inhibitor ◽  
Coronary Syndrome ◽  
Lipid Testing

Abstract 14328: Relation of Lipoprotein(a) Levels to Incident Diabetes and Modification by Alirocumab Treatment: An Analysis of the Odyssey Outcomes Trial

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Gregory G Schwartz ◽  
Michael Szarek ◽  
Marie Baccara-dinet ◽  
Vera A Bittner ◽  
Deepak L Bhatt ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Cohort Studies ◽  
Pcsk9 Inhibitors ◽  
Lipoprotein A ◽  
Pcsk9 Inhibitor ◽  
Coronary Syndrome ◽  
Emerging Therapies ◽  
Lower Baseline ◽  
Healthy Cohort ◽  
Using Data

Background: Cohort studies and clinical trials have shown a greater prevalence of diabetes among subjects with lower levels of lipoprotein(a) [Lp(a)]. Some healthy cohort studies have shown a greater incidence of new onset diabetes (NOD) among those with lower Lp(a). It is unknown whether the risk of NOD associates with Lp(a) levels in patients (pts) with established cardiovascular disease or whether pharmacologic reduction of Lp(a) with PCSK9 inhibitors modulates this risk. Objective: Using data from the ODYSSEY OUTCOMES trial that compared the PCSK9 inhibitor alirocumab (ALI) with placebo (PBO) in pts with recent acute coronary syndrome, we examined whether NOD was related to baseline Lp(a) level and whether any such relationship was modified by ALI treatment. Methods and Results: Lp(a) was measured with a mass assay in 13,480 trial pts without diabetes at baseline; median (IQR) baseline Lp(a) was 21.9 mg/dL (6.9-61.1); median follow-up was 2.7 years. Intensive statin therapy was utilized in 89%. In the PBO group, NOD was greatest in Quartile 1 and least in Quartile 4 of baseline Lp(a) ( Figure , 4.6 vs 3.1 cases per 100 pt-years, P trend 0.0003). ALI lowered Lp(a) by a median of 23% from baseline. Absolute median reduction in Lp(a) with ALI ranged from nil in baseline Lp(a) Quartile 1 to 15 mg/dL in Quartile 4. Treatment HR (ALI/PBO) for NOD was neutral overall (0.95, 95% CI 0.85-1.05) but varied across baseline Lp(a) quartiles from 0.79 (0.64-0.96) in Quartile 1 to 1.09 (0.87-1.38) in Quartile 4 ( Figure , P trend =0.025). Conclusion: In pts with recent acute coronary syndrome, there is greater NOD among those with lower baseline Lp(a) levels. ALI has an overall neutral effect on NOD: In pts with low baseline Lp(a), ALI has minimal effect on Lp(a) levels and tends to reduce NOD. In pts with high baseline Lp(a), ALI reduces Lp(a) levels with a non-significant excess of NOD. The findings may have implications for emerging therapies that reduce Lp(a) more substantially than PCSK9 inhibitors.

P1226Very low achieved low-density lipoprotein cholesterol level with alirocumab treatment after acute coronary syndrome: ODYSSEY OUTCOMES

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
G Schwartz ◽  
M Szarek ◽  
Q H Li ◽  
C E Chiang ◽  
R Diaz ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Haemorrhagic Stroke ◽  
Efficacy And Safety ◽  
Pcsk9 Inhibitor ◽  
Coronary Syndrome ◽  
Onset Diabetes ◽  
New Onset

Abstract Background Recent guidelines for cholesterol management recognize uncertainty regarding long-term efficacy and safety of prolonged very low levels of LDL-C on treatment with a PCSK9 inhibitor, including risk of new-onset diabetes. ODYSSEY OUTCOMES used a treat-to-target approach to demonstrate reduction of coronary heart disease death, non-fatal myocardial infarction, ischaemic stroke, or unstable angina (MACE) with the PCSK9 inhibitor alirocumab (ALI) vs placebo (PBO) in 18,924 patients with recent acute coronary syndrome and elevated LDL-C despite intensive statin therapy. ALI was blindly adjusted (75 or 150 mg dose) to target LDL-C 0.6–1.3 mmol/L (25–50 mg/dL). To avoid sustained very low LDL-C, blind substitution of PBO for ALI was intended if 2 consecutive LDL-C levels were <0.39 mmol/L (15 mg/dL). Patients were followed for median of 2.8 years (maximum of 5 years). Purpose We report the efficacy and safety of ALI in patients who reached very low LDL-C (consecutively <0.39 mmol/L), compared with matched patients from the PBO group. Methods Of 9462 patients randomized to receive ALI, 730 (7.7%) reached very low LDL-C and had substitution of PBO a median 8.3 months after randomization. Using propensity score matching, they were compared (3:1) with 2152 patients initially assigned to PBO. Propensity score matching was also used to compare the incidence of new-onset diabetes in 525 patients without diabetes at baseline who had very low LDL-C levels on ALI with 1675 matched patients in the PBO group. Neurocognitive events and haemorrhagic stroke were also evaluated in relation to very low LDL-C. Results Overall, ALI reduced the incidence of MACE (9.5% vs 11.1%; HR 0.85, 95% CI 0.78–0.93; P<0.001). Characteristics used in propensity score matching (and associated with very low LDL-C on ALI) included sex (male), diabetes (present), baseline LDL-C and lipoprotein(a) (lower), region (Asia), statin treatment, smoking, hypertension, and body mass index. Despite being switched to PBO, patients with very low LDL-C on ALI had fewer MACE than matched patients from the PBO group (6.4% vs 8.5%; HR 0.71, 95% CI 0.52–0.98; P=0.039; Figure). Very low LDL-C on ALI was not associated with risk of new-onset diabetes, compared with matched patients from the PBO group (15.1% vs 13.0%; HR 1.10, 95% CI 0.85–1.43; P=0.46). There was no association of very low LDL-C on ALI with neurocognitive events or haemorrhagic stroke. Conclusions The overall efficacy of ALI on cardiovascular outcomes was not diminished by the patients who had blinded substitution of PBO for sustained very low LDL-C. Despite a short duration of active treatment, these patients had fewer MACE than matched controls from the PBO group. No adverse consequence of very low LDL-C was identified. However, because patients with sustained very low LDL-C were switched to PBO, the long-term safety of more prolonged very low LDL-C, including risk of new-onset diabetes, deserves further study. Acknowledgement/Funding Funded by Sanofi and Regeneron Pharmaceuticals

Abstract #511: HS CRP in Acute Coronary Syndrome

2016 ◽  
Vol 22 ◽  
pp. 121-122
Author(s):  
Mukhyaprana Prabhu ◽  
Shyny Reddy ◽  
Ranjan Shetty ◽  
V.B. Mohan ◽  
Weena Stanley
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Syndrome ◽  
Hs Crp
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