Lipoprotein(a), PCSK9 Inhibition, and Cardiovascular Risk: Insights from the FOURIER Trial
The result's identifiers
Result code in IS VaVaI
<a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F00064165%3A_____%2F19%3A10389049" target="_blank" >RIV/00064165:_____/19:10389049 - isvavai.cz</a>
Alternative codes found
RIV/00216208:11110/19:10389049
Result on the web
<a href="https://verso.is.cuni.cz/pub/verso.fpl?fname=obd_publikace_handle&handle=ncvLBlwyDh" target="_blank" >https://verso.is.cuni.cz/pub/verso.fpl?fname=obd_publikace_handle&handle=ncvLBlwyDh</a>
DOI - Digital Object Identifier
<a href="http://dx.doi.org/10.1161/CIRCULATIONAHA.118.037184" target="_blank" >10.1161/CIRCULATIONAHA.118.037184</a>
Alternative languages
Result language
angličtina
Original language name
Lipoprotein(a), PCSK9 Inhibition, and Cardiovascular Risk: Insights from the FOURIER Trial
Original language description
Background: Lipoprotein(a) [Lp(a)] may play a causal role in atherosclerosis. Proprotein convertase subtilisin/kexin 9 (PCSK9) inhibitors have been shown to significantly reduce plasma Lp(a) concentration. However, the relationship between Lp(a) levels, PCSK9 inhibition and cardiovascular (CV) risk reduction remains undefined. Methods: Lp(a) was measured in 25,096 patients in FOURIER, a randomized trial of evolocumab versus placebo in patients with established atherosclerotic CV disease (median follow-up 2.2 years). Cox models were used to assess the independent prognostic value of Lp(a) and the efficacy of evolocumab for coronary risk reduction by baseline Lp(a) concentration. Results: The median [IQR] baseline Lp(a) concentration was 37[13-165] nmol/L. In the placebo arm, patients with baseline Lp(a) in the highest quartile had a higher risk of coronary heart disease (CHD) death, MI or urgent revascularization (UR) (adjusted HR Q4:Q1 1.22, 95% CI 1.01-1.48) independent of LDL-C. At 48 weeks, evolocumab significantly reduced Lp(a) by a median [IQR] of 26.9% [6.2-46.7%]. The percent change in Lp(a) and LDL-C at 48 weeks in evolocumab patients was moderately positively correlated (r=0.37, 95% CI 0.36-0.39, P<0.001). Evolocumab reduced the risk of CHD death, MI or UR by 23% (HR 0.77, 95% CI 0.67-0.88) in patients with a baseline Lp(a) >median, and by 7% (HR 0.93, 0.80-1.08; P interaction=0.07) in those LESS-THAN OR EQUAL TOmedian. Coupled with the higher baseline risk, the absolute risk reductions and NNT3y were 2.49% and 40 vs. 0.95% and 105, respectively. Conclusions: Lp(a) is associated with the risk of CV events in patients with established CV disease irrespective of LDL-C. Evolocumab significantly reduced Lp(a) levels, and patients with higher baseline Lp(a) levels experienced greater absolute reductions in Lp(a) and tended to derive greater coronary benefit from PCSK9 inhibition. Clinical Trial Registration: URL: https://clinicaltrials.gov Unique Identifier: NCT01764633.
Czech name
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Czech description
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Classification
Type
J<sub>imp</sub> - Article in a specialist periodical, which is included in the Web of Science database
CEP classification
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OECD FORD branch
30201 - Cardiac and Cardiovascular systems
Result continuities
Project
—
Continuities
N - Vyzkumna aktivita podporovana z neverejnych zdroju
Others
Publication year
2019
Confidentiality
S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů
Data specific for result type
Name of the periodical
Circulation
ISSN
0009-7322
e-ISSN
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Volume of the periodical
139
Issue of the periodical within the volume
12
Country of publishing house
US - UNITED STATES
Number of pages
10
Pages from-to
1483-1492
UT code for WoS article
000469318300005
EID of the result in the Scopus database
2-s2.0-85061789282