Kröger Knut, Espinola-Klein Christine, Hoffmann Ulrich, Kalka Christoph, Lawall Holger, Weiss Norbert
Klinik für Gefäßmedizin, HELIOS Klinik Krefeld.
Abteilung für Angiologie, Zentrum für Kardiologie/Kardiologie I, Universitätsmedizin der Johannes-Gutenberg-Universität, Mainz.
Dtsch Med Wochenschr. 2018 Sep;143(19):1391-1396. doi: 10.1055/a-0639-8325. Epub 2018 Jul 4.
The guideline of the European Society of Cardiology recommends an LDL-C target < 70 mg/dL or a 50 % reduction in patients with manifest peripheral arterial disease (PAD) as well as in CHD or cerebrovascular disease when the baseline LDL-C is between 70 and 135 mg/dL. Application of a PCSK9 inhibitor allows target attainment for those patients who do not achieve this under maximal conventional therapy with a statin in combination with ezetemib. In the Fourier study, patients with PAOD who had neither a myocardial infarction nor a stroke at admission of the study had a significant risk reduction (RR) of both cardiovascular (RR = 0.67, 0.47 - 0.96, p = 0.0283) as well as extremity endpoints (RR = 0.43 (0.19 - 0.99; p = 0.042). In Germany these patients are primarily seen by angiologists. This group of vascular specialists is specifically mentioned in the decision of the Federal Joint Committee as one of those who may indicate treatment with PCSK9 inhibitors.
欧洲心脏病学会指南建议，对于患有明显外周动脉疾病（PAD）以及冠心病或脑血管疾病且基线低密度脂蛋白胆固醇（LDL-C）在70至135mg/dL之间的患者，将LDL-C目标设定为<70mg/dL或降低50%。对于那些在使用他汀类药物联合依折麦布进行最大程度的传统治疗下仍未达到该目标的患者，应用前蛋白转化酶枯草溶菌素9（PCSK9）抑制剂可使其达到目标。在FOURIER研究中，入组时既无心肌梗死也无中风的外周动脉闭塞性疾病（PAOD）患者，心血管事件（风险比[RR]=0.67，0.47 - 0.96，p=0.0283）以及肢体终点事件（RR=0.43（0.19 - 0.99；p=0.042））的风险均显著降低。在德国，这些患者主要由血管病专家诊治。联邦联合委员会的决定特别提到，这组血管专科医生是可能开具PCSK9抑制剂治疗的人员之一。
