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dc.contributor.authorSchwartz, GG
dc.contributor.authorSzarek, M
dc.contributor.authorBittner, VA
dc.contributor.authorDiaz, R
dc.contributor.authorGoodman, SG
dc.contributor.authorJukema, JW
dc.contributor.authorLandmesser, U
dc.contributor.authorLópez-Jaramillo, P
dc.contributor.authorManvelian, G
dc.contributor.authorPordy, R
dc.contributor.authorScemama, M
dc.contributor.authorSinnaeve, PR
dc.contributor.authorChua, T
dc.contributor.authorCoverdale, Steven
dc.contributor.authoret al.
dc.date.accessioned2021-08-10T02:55:47Z
dc.date.available2021-08-10T02:55:47Z
dc.date.issued2021
dc.identifier.issn0735-1097
dc.identifier.doi10.1016/j.jacc.2021.04.102
dc.identifier.urihttp://hdl.handle.net/10072/406726
dc.description.abstractBackground: Guidelines recommend nonstatin lipid-lowering agents in patients at very high risk for major adverse cardiovascular events (MACE) if low-density lipoprotein cholesterol (LDL-C) remains ≥70 mg/dL on maximum tolerated statin treatment. It is uncertain if this approach benefits patients with LDL-C near 70 mg/dL. Lipoprotein(a) levels may influence residual risk. Objectives: In a post hoc analysis of the ODYSSEY Outcomes (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab) trial, the authors evaluated the benefit of adding the proprotein subtilisin/kexin type 9 inhibitor alirocumab to optimized statin treatment in patients with LDL-C levels near 70 mg/dL. Effects were evaluated according to concurrent lipoprotein(a) levels. Methods: ODYSSEY Outcomes compared alirocumab with placebo in 18,924 patients with recent acute coronary syndromes receiving optimized statin treatment. In 4,351 patients (23.0%), screening or randomization LDL-C was <70 mg/dL (median 69.4 mg/dL; interquartile range: 64.3-74.0 mg/dL); in 14,573 patients (77.0%), both determinations were ≥70 mg/dL (median 94.0 mg/dL; interquartile range: 83.2-111.0 mg/dL). Results: In the lower LDL-C subgroup, MACE rates were 4.2 and 3.1 per 100 patient-years among placebo-treated patients with baseline lipoprotein(a) greater than or less than or equal to the median (13.7 mg/dL). Corresponding adjusted treatment hazard ratios were 0.68 (95% confidence interval [CI]: 0.52-0.90) and 1.11 (95% CI: 0.83-1.49), with treatment-lipoprotein(a) interaction on MACE (Pinteraction = 0.017). In the higher LDL-C subgroup, MACE rates were 4.7 and 3.8 per 100 patient-years among placebo-treated patients with lipoprotein(a) >13.7 mg/dL or ≤13.7 mg/dL; corresponding adjusted treatment hazard ratios were 0.82 (95% CI: 0.72-0.92) and 0.89 (95% CI: 0.75-1.06), with Pinteraction = 0.43. Conclusions: In patients with recent acute coronary syndromes and LDL-C near 70 mg/dL on optimized statin therapy, proprotein subtilisin/kexin type 9 inhibition provides incremental clinical benefit only when lipoprotein(a) concentration is at least mildly elevated. (ODYSSEY Outcomes: Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab; NCT01663402)
dc.description.peerreviewedYes
dc.languageen
dc.publisherElsevier BV
dc.relation.ispartofpagefrom421
dc.relation.ispartofpageto433
dc.relation.ispartofissue5
dc.relation.ispartofjournalJournal of the American College of Cardiology
dc.relation.ispartofvolume78
dc.subject.fieldofresearchCardiovascular medicine and haematology
dc.subject.fieldofresearchcode3201
dc.titleLipoprotein(a) and Benefit of PCSK9 Inhibition in Patients With Nominally Controlled LDL Cholesterol
dc.typeJournal article
dc.type.descriptionC1 - Articles
dcterms.bibliographicCitationSchwartz, GG; Szarek, M; Bittner, VA; Diaz, R; Goodman, SG; Jukema, JW; Landmesser, U; López-Jaramillo, P; Manvelian, G; Pordy, R; Scemama, M; Sinnaeve, PR; Chua, T; Coverdale, S; et al., Lipoprotein(a) and Benefit of PCSK9 Inhibition in Patients With Nominally Controlled LDL Cholesterol, Journal of the American College of Cardiology, 2021, 78 (5), pp. 421-433
dcterms.licensehttp://creativecommons.org/licenses/by-nc-nd/4.0/
dc.date.updated2021-08-09T03:31:48Z
dc.description.versionVersion of Record (VoR)
gro.rights.copyright© 2021 the authors. Published by elsevier on behalf of the american college of cardiology fo undation. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International (CC BY-NC-ND 4.0) License, which permits unrestricted, non-commercial use, distribution and reproduction in any medium, providing that the work is properly cited.
gro.hasfulltextFull Text
gro.griffith.authorCoverdale, Steven
gro.griffith.authorChua, Terence


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