aSouth Australian Health and Medical Research Institute bUniversity of Adelaide, Australia cQuébec Heart & Lung Institute, Québec, Canada dCleveland Clinic Coordinating Center for Clinical Research, Cleveland, Ohio, USA.
Curr Opin Lipidol. 2017 Dec;28(6):465-469. doi: 10.1097/MOL.0000000000000458.
Proprotein convertase subtilisin kexin type 9 (PCSK9) inhibition has emerged as a novel approach to lowering levels of low-density lipoprotein cholesterol (LDL-C). The impact of PCSK9 inhibition in statin-treated patients on coronary atherosclerosis had remained unknown.
The GLAGOV trial compared the effect of the PCSK9 inhibitor, evolocumab, and placebo on progression of coronary atherosclerosis in patients treated with at least moderate intensity statin therapy. Predictable lowering of LDL-C with evolocumab (36.6 versus 93.0 mg/dl) associated with significant regression of coronary atherosclerosis. A direct relationship was observed between achieved LDL-C levels and disease progression.
Addition of evolocumab to statin therapy produces incremental regression of plaque regression in patients with established coronary artery disease. This finding provides a biological rationale for the reported beneficial effects of evolocumab on cardiovascular events.
前蛋白转化酶枯草溶菌素 9（PCSK9）抑制剂的出现为降低低密度脂蛋白胆固醇（LDL-C）水平提供了一种新方法。PCSK9 抑制剂在他汀类药物治疗患者中的应用对冠状动脉粥样硬化的影响尚不清楚。
GLAGOV 试验比较了 PCSK9 抑制剂依洛尤单抗和安慰剂对至少接受中等强度他汀类药物治疗的患者冠状动脉粥样硬化进展的影响。依洛尤单抗（36.6 与 93.0mg/dl）可预测性地降低 LDL-C，与冠状动脉粥样硬化的显著消退相关。观察到 LDL-C 水平与疾病进展之间存在直接关系。
依洛尤单抗联合他汀类药物治疗可使已确诊冠心病患者的斑块消退得到进一步改善。这一发现为依洛尤单抗对心血管事件的有益作用提供了生物学依据。
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