Ikegami Yuichi, Inoue Ikuo, Inoue Kaiji, Shinoda Yuichi, Iida Shinichiro, Goto Seiichi, Nakano Takanari, Shimada Akira, Noda Mistuhiko
1Department of Endocrinology and Diabetology, Saitama Medical University, 38 Moroyama, Iruma-gun, Saitama 350-0495 Japan.
2Department of Radiology, Saitama Medical University, 38 Moroyama, Iruma-gun, Saitama 350-0495 Japan.
NPJ Aging Mech Dis. 2018 Jun 22;4:7. doi: 10.1038/s41514-018-0026-2. eCollection 2018.
Statins and/or PCSK9 inhibitors cause the regression of coronary atheroma and reduce clinical events. However, it currently remains unclear whether these drugs modulate coronary atheroma calcification in vivo. Coronary artery calcium (CAC) scores (Agatston Units, AUs) were estimated in 120 patients receiving coronary computed tomographic angiography (CCTA) (63% males; median age 56 years). The CAC scores were compared among the three groups: (1) neither statin nor PCSK9 inhibitor therapy, (2) statin monotherapy, and (3) statin and PCSK9 inhibitor combination therapy in an unpaired cross-sectional study. Additionally, CCTA was performed twice at an interval in 15 patients undergoing statin monotherapy to compare the previous (baseline) and subsequent (follow-up) CAC scores in a paired longitudinal study. In addition, a PCSK9 inhibitor was administered to 16 patients undergoing statin therapy. Before and after that, CCTA was performed twice to compare the previous and subsequent CAC scores in a paired longitudinal study. The unpaired cross-sectional study and paired longitudinal study consist of completely different patients. Among 120 patients, 40 (33%) had a CAC score >100 AUs. The median CAC score increased in the following order: statin group, statin and PCSK9 group, and no-statin-no-PCSK9 group. Annual CAC score progression was 29.7% by statin monotherapy and 14.3% following the addition of the PCSK9 inhibitor to statin therapy. The annual rate of CAC with the combination therapy with a PCSK9 inhibitor and a statin is lower than that with statin monotherapy. CAC may be prevented with PCSK9 Inhibitor.
他汀类药物和/或前蛋白转化酶枯草溶菌素9（PCSK9）抑制剂可使冠状动脉粥样硬化消退并减少临床事件。然而，目前尚不清楚这些药物在体内是否会调节冠状动脉粥样硬化钙化。对120例接受冠状动脉计算机断层扫描血管造影（CCTA）的患者（63%为男性；中位年龄56岁）进行了冠状动脉钙化（CAC）评分（阿加斯顿单位，AUs）评估。在一项非配对横断面研究中，比较了三组患者的CAC评分：（1）未接受他汀类药物和PCSK9抑制剂治疗，（2）他汀类药物单药治疗，以及（3）他汀类药物与PCSK9抑制剂联合治疗。此外，在一项配对纵向研究中，对15例接受他汀类药物单药治疗的患者进行了两次间隔的CCTA检查，以比较之前（基线）和随后（随访）的CAC评分。另外，对16例接受他汀类药物治疗的患者给予PCSK9抑制剂。在此之前和之后，进行了两次CCTA检查，以在配对纵向研究中比较之前和随后的CAC评分。非配对横断面研究和配对纵向研究由完全不同的患者组成。在120例患者中，40例（33%）的CAC评分>100 AUs。中位CAC评分按以下顺序升高：他汀类药物组、他汀类药物与PCSK9抑制剂组、未用他汀类药物未用PCSK9抑制剂组。他汀类药物单药治疗的年度CAC评分进展为29.7%，在他汀类药物治疗中添加PCSK9抑制剂后为14.3%。PCSK9抑制剂与他汀类药物联合治疗的年度CAC发生率低于他汀类药物单药治疗。PCSK9抑制剂可能预防CAC。
