Background

Lipoprotein(a) [Lp(a)] is an atherogenic lipoprotein associated with atherosclerotic cardiovascular disease. Niacin and proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) both lower Lp(a).

Objective

The objective of the study was to determine if addition of PCSK9i to background niacin therapy further lowers Lp(a).

Methods

This study is a retrospective analysis of patients who met the following inclusion criteria: initiated PCSK9i therapy, had Lp(a) measurements before and after initiation of PCSK9i, and for the combination therapy group, PCSK9i was added on top of baseline niacin monotherapy. Of the 150 patients included in this study, 136 were on monotherapy (PCSK9i) and 14 were on combination therapy (niacin + PCSK9i). Lp(a) values were assessed in both groups before and after the addition of PCSK9i.

Results

Median percent and absolute Lp(a) reductions in the niacin + PCSK9i combination therapy group were −15.3% (interquartile range [IQR] −31.8, −1) and −9 mg/dL (IQR −37.2, −0.5), respectively, from a baseline Lp(a) of 95 mg/dL (IQR 20.5, 171). These reductions were statistically significant or nearly so (P = .04 and P = .05, respectively). Median percent and absolute Lp(a) reductions in the PCSK9i monotherapy group were −17.3% (IQR −34.4, 0) and −6 mg/dL (IQR −16, 0), respectively, from a baseline Lp(a) of 39.5 mg/dL (IQR 15, 117.5). There was no difference in median percent and absolute change in Lp(a) between monotherapy and combination therapy groups (P = .84 and P = .54, respectively).

Conclusions

Our study demonstrates that the addition of PCSK9i to background of niacin therapy is associated with ∼15% reduction in Lp(a) beyond that achieved with background niacin monotherapy.

中文翻译：

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在有或没有烟酸治疗背景下，PCSK9抑制剂对血浆脂蛋白（a）浓度的影响。

背景

脂蛋白（a）[Lp（a）]是与动脉粥样硬化性心血管疾病相关的动脉粥样硬化脂蛋白。烟酸和前蛋白转化酶枯草杆菌蛋白酶/ kexin 9型抑制剂（PCSK9i）均可降低Lp（a）。

客观的

该研究的目的是确定在背景烟酸治疗中添加PCSK9i是否进一步降低Lp（a）。

方法

这项研究是对符合以下纳入标准的患者的回顾性分析：启动PCSK9i治疗，在启动PCSK9i之前和之后进行Lp（a）测量，对于联合治疗组，在基线烟酸单药治疗的基础上增加PCSK9i。在这项研究中包括的150位患者中，有136位接受了单一疗法（PCSK9i），有14位接受了联合疗法（烟酸+ PCSK9i）。在添加PCSK9i之前和之后，两组均评估了Lp（a）值。

结果

烟酸+ PCSK9i联合治疗组的Lp（a）降低中位数百分比和绝对值分别为-15.3％（四分位间距[IQR] -31.8，-1）和-9 mg / dL（IQR -37.2，-0.5）。基线Lp（a）为95 mg / dL（IQR 20.5，171）。这些减少在统计上是显着的或接近于统计学的（分别为P  = .04和P  = .05）。与基线Lp（a）的39.5相比，PCSK9i单药治疗组的中位百分比降低和绝对Lp（a）降低分别为-17.3％（IQR -34.4，0）和-6 mg / dL（IQR -16，0）。毫克/分升（IQR 15，117.5）。单药治疗和联合治疗组之间Lp（a）的中位数百分比和绝对变化无差异（分别为P  = 0.84和P  = 0.54）。

结论

我们的研究表明，在烟酸治疗的背景中添加PCSK9i可使Lp（a）降低约15％，超过了背景烟酸单一疗法所能达到的Lp（a）降低。