超高危ASCVD患者应用二十碳五烯酸乙酯的真实世界研究

    Real-world study on the efficacy of icosapent ethyl in patients with very high-risk atherosclerotic cardiovascular disease

      摘要
    • 摘要:
      目的 观察超高危动脉粥样硬化心血管疾病（ASCVD）患者在常规治疗基础上联合使用二十碳五烯酸乙酯的降脂疗效与降低心血管事件预后效果。
      方法 选取2023年10月～2023年11月在空军军医大学第一附属医院收治的超高危ASCVD合并PCI术后患者，根据是否使用二十碳五烯酸乙酯（IPE），分为IPE组（n=60）和对照组（n=60），采用倾向评分匹配法进行混杂因素调整。IPE组使用二十碳五烯酸乙酯联合常规治疗，对照组使用常规治疗，随访真实世界中患者出院后血脂水平等生化检查及心血管不良事件。
      结果 经过1∶1倾向评分匹配后，两组共有120例患者，IPE组与对照组患者的性别、年龄、地理区域、血脂基线水平、高血压病史、糖尿病史、冠状动脉疾病史、等所有基线特征均均衡，组间差异不具有统计学意义。两组患者1年后随访，IPE组TG水平低于对照组，HDL-C水平高于对照组，差异具有统计学意义（均P<0.05）。IPE组不稳定心绞痛事件发生率低于对照组，差异具有统计学意义（P<0.05）。其余心血管事件发生率低于对照组，但无统计学差异； IPE组患者1年后TC、TG、LDL-C水平低于基线水平（均P<0.01），HDL-C水平高于基线水平（P<0.05）。
      结论  超高危ASCVD患者在常规降低LDL-C治疗药物的基础上，联合二十碳五烯酸乙酯相较于单纯的降LDL-C药物治疗，能更全面的改善血脂水平。二十碳五烯酸乙酯通过发挥其多重作用机制，降低患者不稳定心绞痛发生率。

       

      Abstract:
      AIM  To assess the lipid-lowering efficacy and the impact on reducing cardiovascular risk prognosis of icosapent ethyl (IPE) in patients with very high-risk atherosclerotic cardiovascular disease (ASCVD) who were undergoing conventional treatment.
      METHODS  From October 2023 to November 2023, very high-risk ASCVD patients who had undergone percutaneous coronary intervention (PCI) were recruited from the First Affiliated Hospital of the Air Force Medical University. These patients were divided into a treatment group (n=60) and a control group (n=60). Propensity score matching (PSM) was employed to adjust for confounding factors. The treatment group received icosapent ethyl in combination with conventional lipid-lowering therapy, while the control group only received conventional lipid-lowering treatment. In a real-world setting, biochemical indicators, including blood lipid levels, and cardiovascular adverse events of the patients were recorded.
      RESULTS After 1∶1 propensity score matching, there were 120 patients in the two groups. The gender, age, geographical region, blood lipid baseline level, hypertension history, diabetes history, coronary artery disease history and other baseline characteristics of patients in IPE group and control group were balanced, and the difference between the groups was not statistically significant. Two groups of patients were followed up after one year, and the TG level in the IPE group was lower than that in the control group, while the HDL-C level was higher than that in the control group, with statistically significant differences (both P<0.05). The incidence of unstable angina events in the IPE group was lower than that in the control group, and the difference was statistically significant (P<0.05). The incidence of other cardiovascular events was lower than that of the control group, but there was no statistical difference; One year later, the levels of TC, TG, and LDL-C in the IPE group were lower than baseline levels (all P<0.01), while the level of HDL-C was higher than baseline levels (P<0.05).
      CONCLUSION The combinationof icosapent ethyl with conventional LDL-lowering drugs provides more comprehensive blood lipids improvement when compared with LDL-lowering drugsalone. Icosapent ethyl treatment also reduces unstable angina incidence.

       

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