Department of Medicine, Cardiovascular Medicine Division, University of Maryland School of Medicine, 110 S Paca St., Suite 7-124, Baltimore, MD, 21201, USA.
Curr Cardiol Rep. 2018 Jul 10;20(9):71. doi: 10.1007/s11886-018-1013-8.
Assessing the cardiovascular risk associated with hypertriglyceridemia can be challenging due to frequent confounding conditions such as hypertension, diabetes mellitus, and hyperlipidemia. We sought to quantify this risk by examining several meta-analyses as well as subgroup analyses of previously published major randomized controlled trials that focused on the treatment of hyperlipidemia.
Recent trials measuring the effects of PCSK9 inhibitors such as evolocumab and alirocumab on cardiovascular outcomes have demonstrated a high degree of residual cardiovascular risk even after profound reductions in low-density-lipoprotein cholesterol (LDL-C). Despite optimization of LDL-C through the use of statins, PCSK9 inhibitors and adjunctive therapies such as ezetimibe, bile acid sequestrants and niacin, residual cardiovascular risk remains significant. Several ongoing trials are assessing the efficacy of pemafibrate and omega-3 fatty acids for the treatment of hypertriglyceridemia and their effects on major cardiovascular outcomes.
由于高血压、糖尿病和高脂血症等常见混杂因素的存在，评估高甘油三酯血症相关的心血管风险具有一定挑战性。我们通过检查几项荟萃分析以及之前发表的重点关注高脂血症治疗的大型随机对照试验的亚组分析，来量化这种风险。
最近的试验测量了 PCSK9 抑制剂（如依洛尤单抗和阿利西尤单抗）对心血管结局的影响，结果表明，即使低密度脂蛋白胆固醇（LDL-C）显著降低，仍存在高度的残余心血管风险。尽管通过使用他汀类药物优化了 LDL-C，但 PCSK9 抑制剂和依折麦布、胆汁酸螯合剂和烟酸等辅助治疗仍存在显著的残余心血管风险。目前正在进行几项试验评估 pemafibrate 和 ω-3 脂肪酸治疗高甘油三酯血症的疗效及其对主要心血管结局的影响。
