Alirocumab and cardiovascular outcomes according to sex and lipoprotein(a) after acute coronary syndrome: a report from the ODYSSEY OUTCOMES study

作者：Vera Bittner, Gregory G. Schwartz, Deepak L. Bhatt, Terrance Chua, H. Asita De Silva, Rafael Díaz, Shaun G. Goodman, Robert A. Harrington, J. Wouter Jukema, Jennifer McGinniss, Robert Pordy, Geneviève Garon, Michel Scemama, Harvey D. White, Philippe Gabríel Steg, Michael Szarek · 发表于：Journal of clinical lipidology · 年份：2024 · DOI：10.1016/j.jacl.2024.04.122 · 被引用次数：22 · 研究领域：Lipoproteins and Cardiovascular Health、Acute Myocardial Infarction Research、Protease and Inhibitor Mechanisms

Background The ODYSSEY OUTCOMES trial (NCT01663402) compared the effects of the proprotein convertase subtilisin/kexin type 9 inhibitor alirocumab with placebo on major adverse cardiovascular events (MACE) in patients with recent acute coronary syndrome (ACS). Objective We assessed efficacy and safety of alirocumab versus placebo according to sex and lipoprotein(a) level. Methods This prespecified analysis compared the effects of alirocumab versus placebo on lipoproteins, MACE (coronary heart disease death, non-fatal myocardial infarction, fatal/non-fatal ischemic stroke, unstable angina requiring hospitalization), death, total cardiovascular events, and adverse events in 4762 women and 14,162 men followed for a median of 2.8 years. In post-hoc analysis, we evaluated total cardiovascular events according to sex, baseline lipoprotein(a), and treatment. Results Women were older, had higher baseline LDL-C levels (89.6 vs 85.3 mg/dL) and lipoprotein(a) (28.0 vs 19.3 mg/dL) and had more co-morbidities than men. At 4 months, alirocumab lowered LDL-C by 49.4 mg/dL in women and 54.0 mg/dL in men and lipoprotein(a) by 9.7 and 8.1 mg/dL, respectively (both p<0.0001). Alirocumab reduced MACE, death, and total cardiovascular events similarly in both sexes. In the placebo group, lipoprotein(a) was a risk factor for total cardiovascular events in women and men. In both sexes, reduction of total cardiovascular events was greater at higher baseline lipoprotein(a), but this effect was more ev...