Chairman, Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.
Cleveland Clinic Coordinating Center for Clinical Research (C5Research), Cleveland Clinic, Cleveland, OH, USA.
Cleve Clin J Med. 2017 Dec;84(12 Suppl 4):e1-e5. doi: 10.3949/ccjm.84.s4.01.
Statins therapy reduces atheroma in proportion to the reduction of low-density lipoprotein cholesterol (LDL-C). Proprotein convertase subtilisin--kexin type 9 (PCSK9) inhibitors are a new class of injectable human monoclonal antibodies shown to lower LDL-C when added to statin therapy. In a randomized, double-blind, placebo-controlled study, 968 patients with symptomatic coronary artery disease were treated with statins alone or combined with the PCSK9 inhibitor, evolocumab, and assessed for change in percent, total volume, and regression of coronary atheroma. Treatment with statins plus evolocumab achieved mean LDL-C levels of 36.6 mg/dL, produced atheroma regression with a mean change in percent of atheroma volume of about 1% (P < .001), and induced regression in a greater percentage of patients. The clinical benefits of LDL-C as low as 20 mg/dL shown in this trial warrant further investigation.
他汀类药物治疗可使动脉粥样硬化斑块体积按 LDL-C 降低幅度成比例缩小。前蛋白转化酶枯草溶菌素 9（PCSK9）抑制剂是一种新型的可注射人源单克隆抗体，与他汀类药物联合使用可降低 LDL-C。在一项随机、双盲、安慰剂对照的研究中，968 例有症状的冠心病患者接受他汀类药物单独治疗或联合 PCSK9 抑制剂依洛尤单抗治疗，并评估其动脉粥样硬化斑块体积百分比、总容积和消退的变化。他汀类药物加依洛尤单抗治疗可使 LDL-C 平均水平达到 36.6 mg/dL，斑块体积百分比平均变化约 1%（P<0.001），且可使更多患者的斑块消退。该试验中 LDL-C 低至 20 mg/dL 所带来的临床获益值得进一步研究。
