Hernandez-Sómerson Mario Andres, Montoya-Agudelo Fernando, Huertas-Rodriguez Gustavo
Department of Medical Clinics, Hospital Universitario Mayor - MEDERI, 111411, Bogotá, Colombia.
Universidad del Rosario, 111411, Bogotá, Colombia.
Int J Cardiol Cardiovasc Risk Prev. 2024 Jun 15;22:200298. doi: 10.1016/j.ijcrp.2024.200298. eCollection 2024 Sep.
The objective of this research is to evaluate the efficacy and safety of drugs in the residual risk in any of its three components: lipid, inflammatory and thrombotic risk.
A systematic review was conducted of randomized clinical trials that included as a primary outcome, at least one of the conditions related to atherosclerotic cardiovascular disease. The databases used were PUBMED/MEDLINE, Scopus and ClinicalTrials.gov. The risk of bias of the studies was assessed using the Risk of Bias 2 tool.
and discussion: 18 studies were included in the analysis. Half of the studies had low risk of bias or some concerns. Several drugs were effective in reducing the primary outcome: ethyl eicosapentaenoeic acid (17.2 % E-EPA versus 22 % placebo HR: 0.75; 95 % CI 0.68-0.83; p < 0.001), colchicine in stable coronary artery disease (6.8 % vs placebo 9.6 %, HR 0.59, 95 % CI 0.57-0.83; p < 0.001), Canakinumab (150 mg vs placebo ARR 15 %, HR 0.85, 95 % CI 0.74-0.98; p = 0.021) and Rivaroxaban with Aspirin in stable atherosclerotic disease (4.1 % versus aspirin 5.4 %, HR 0.76, 95 % CI 0.66-0.86, P < 0.001). Serious adverse events did not differ between study groups, except for a higher rate of bleeding with the use of combination antithrombotic therapy.
The residual risk can be reduced through the use of different drugs that act by modifying atherogenic lipid levels, modulating inflammatory pathways and the risk of thrombosis, with an acceptable safety profile in most studies.
本研究的目的是评估药物在残余风险的三个组成部分（脂质、炎症和血栓形成风险）中的疗效和安全性。
对随机临床试验进行系统评价，这些试验将至少一种与动脉粥样硬化性心血管疾病相关的病症作为主要结局。使用的数据库有PUBMED/MEDLINE、Scopus和ClinicalTrials.gov。采用偏倚风险2工具评估研究的偏倚风险。
分析纳入了18项研究。一半的研究偏倚风险较低或存在一些问题。几种药物在降低主要结局方面有效：二十碳五烯酸乙酯（17.2%的二十碳五烯酸乙酯与22%的安慰剂相比，风险比：0.75；95%置信区间0.68 - 0.83；p < 0.001）、用于稳定型冠状动脉疾病的秋水仙碱（6.8%与安慰剂9.6%相比，风险比0.59，95%置信区间0.57 - 0.83；p < 0.001）、卡那单抗（150毫克与安慰剂相比，绝对风险降低率15%，风险比0.85，95%置信区间0.74 - 0.98；p = 0.021）以及利伐沙班联合阿司匹林用于稳定型动脉粥样硬化疾病（4.1%与阿司匹林组的5.4%相比，风险比0.76，95%置信区间0.66 - 0.86，P < 0.001）。除联合抗血栓治疗导致的出血率较高外，各研究组之间严重不良事件无差异。
通过使用不同药物可降低残余风险，这些药物通过改变致动脉粥样硬化的脂质水平、调节炎症途径和血栓形成风险发挥作用，在大多数研究中具有可接受的安全性。
