Ma Hui, Ma Wenfang, Liu Yang, Chen Lixing, Ding Peng
Department of Cardiology, The First Affiliated Hospital of Kunming Medical University, 650032 Kunming, Yunnan, China.
Rev Cardiovasc Med. 2025 Apr 25;26(4):26980. doi: 10.31083/RCM26980. eCollection 2025 Apr.
A meta-analysis was conducted to determine whether the cardiovascular mortality and lipid-lowering effects of alirocumab and evolocumab are influenced by various baseline low-density lipoprotein cholesterol (LDL-C) levels.
We searched for literature published before June 2023. Eligible randomized controlled trials (RCTs) included adults treated with alirocumab or evolocumab and reported LDL-C changes and cardiovascular deaths. The primary endpoints were cardiovascular mortality and percent changes in LDL-C from baseline.
Forty-one RCTs were included in the meta-analysis. Evolocumab did not significantly affect the outcome of cardiovascular mortality whether the baseline data were greater than 100 mg/dL or less than 100 mg/dL. However, the stratified result showed that alirocumab decreased the risk of cardiovascular mortality in patients with a baseline LDL-C level of ≥100 mg/dL (relative risk (RR) 0.45; 95% CI: 0.22 to 0.92; = 0.03). In terms of lipid-lowering efficacy, alirocumab (mean difference (MD) -56.62%; 95% CI: -60.70% to -52.54%; < 0.001) and evolocumab (MD -68.10%; 95% CI: -74.85% to -61.36%; < 0.001) yielded the highest percentage reduction in LDL-C level when baseline levels were 70-100 mg/dL, while the smallest reduction in alirocumab (MD -37.26%; 95% CI: -44.06% to -30.46%; < 0.001) and evolocumab (MD -37.55%; 95% CI: -40.47% to -34.63%; < 0.001) occurred with baseline LDL-C levels of ≥160 mg/dL.
Alirocumab and evolocumab presented a better lipid-lowering effect when the baseline LDL-C levels were <100 mg/dL. Alirocumab was associated with a significant reduction in cardiovascular mortality at baseline LDL-C levels of ≥100 mg/dL. This finding can have significant implications for the development of personalized drug therapy.
CRD42023446723, https://www.crd.york.ac.uk/PROSPERO/view/CRD42023446723.
进行了一项荟萃分析，以确定阿利西尤单抗和依洛尤单抗的心血管死亡率及降脂效果是否受各种基线低密度脂蛋白胆固醇（LDL-C）水平的影响。
我们检索了2023年6月之前发表的文献。符合条件的随机对照试验（RCT）包括接受阿利西尤单抗或依洛尤单抗治疗的成年人，并报告了LDL-C变化和心血管死亡情况。主要终点是心血管死亡率和LDL-C相对于基线的百分比变化。
荟萃分析纳入了41项RCT。无论基线数据大于100mg/dL还是小于100mg/dL，依洛尤单抗对心血管死亡率结局均无显著影响。然而，分层结果显示，基线LDL-C水平≥100mg/dL的患者中，阿利西尤单抗降低了心血管死亡风险（相对风险（RR）0.45；95%置信区间：0.22至0.92；P = 0.03）。在降脂疗效方面，当基线水平为70 - 100mg/dL时，阿利西尤单抗（平均差值（MD）-56.62%；95%置信区间：-60.70%至-52.54%；P < 0.001）和依洛尤单抗（MD -68.10%；95%置信区间：-74.85%至-6-1.36%；P < 0.001）使LDL-C水平降低的百分比最高，而当基线LDL-C水平≥160mg/dL时，阿利西尤单抗（MD -37.26%；95%置信区间：-44.06%至-30.46%；P < 0.001）和依洛尤单抗（MD -37.55%；95%置信区间：-40.47%至-34.63%；P < 0.001）降低的幅度最小。
当基线LDL-C水平<100mg/dL时，阿利西尤单抗和依洛尤单抗呈现出更好的降脂效果。在基线LDL-C水平≥100mg/dL时，阿利西尤单抗与心血管死亡率的显著降低相关。这一发现可能对个性化药物治疗的发展具有重要意义。
PROSPERO注册号：CRD42023446723，https://www.crd.york.ac.uk/PROSPERO/view/CRD42023446723 。
