Victorian Heart Institute, Monash University, Clayton, Victoria, Australia.
Curr Opin Cardiol. 2023 Nov 1;38(6):504-508. doi: 10.1097/HCO.0000000000001080. Epub 2023 Sep 25.
The aim of this study was to review the impact of combination lipid lowering with statins and proprotein convertase subtilisin kexin type 9 (PCSK9) inhibitors on coronary atherosclerosis using serial intravascular imaging.
Early studies using intravascular ultrasound established the ability of increasingly intensive lipid lowering to both slow progression and ultimately promote regression of coronary disease. More recent clinical trials that have employed serial imaging with optical coherence tomography have permitted the ability to evaluate the impact of intensive lipid lowering on compositional features associated with plaque vulnerability. In particular, the combination of intensive statin and PCSK9 inhibitor therapy promotes plaque stability in patients following an acute coronary syndrome.
More intensive lipid lowering using the combination of statins and PCSK9 inhibitors promote plaque regression in addition to promoting calcification, fibrous cap thickening and reductions in plaque lipid. These plaque-stabilizing effects underscore the benefits of combination therapy on cardiovascular events and highlight the importance of combination lipid-lowering therapy.
本研究旨在通过连续血管内成像来综述联合降脂治疗（他汀类药物与前蛋白转化酶枯草溶菌素 9[PCSK9]抑制剂）对冠状动脉粥样硬化的影响。
早期应用血管内超声的研究确立了逐渐强化降脂治疗在减缓、甚至最终促进冠状动脉疾病消退方面的能力。最近采用光学相干断层扫描进行连续成像的临床试验使我们能够评估强化降脂治疗对与斑块脆弱性相关的组成特征的影响。特别地，强化他汀类药物与 PCSK9 抑制剂联合治疗可促进急性冠状动脉综合征患者的斑块稳定。
联合应用他汀类药物和 PCSK9 抑制剂进行更强化的降脂治疗除了促进钙化、纤维帽增厚和斑块脂质减少外，还可促进斑块消退。这些斑块稳定作用突出了联合治疗对心血管事件的益处，并强调了联合降脂治疗的重要性。
