How safe are proprotein convertase subtilisinekexin type 9 inhibitors in diabetes?

IF 3.8 3区 医学 Q2 BIOCHEMISTRY & MOLECULAR BIOLOGY Current opinion in lipidology Pub Date : 2024-08-01 Epub Date: 2024-03-19 DOI:10.1097/MOL.0000000000000934
Tian Chen, Naifeng Liu
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Abstract

Purpose of review: To examine the safety of proprotein convertase subtilisinekexin type 9 (PCSK9) inhibitors in patients with diabetes, specifically focusing on their impact on glucose metabolism.

Recent findings: Patients with diabetes often require intensified lipid-lowering therapy. PCSK9 inhibitors can reduce low-density lipoprotein cholesterol (LDL-C) concentrations by approximately 60%, and significantly reduce cardiovascular risk when added to statin therapy. Some studies have suggested an association between low LDL-C levels and an increased risk of new-onset diabetes, and genetics has almost consistently shown an increased glucose concentration and risk of diabetes. Most clinical trials have not demonstrated a deterioration in glycaemic control in patients with diabetes after the use of PCSK9 inhibitors, and they do not lead to other significant treatment-emergent adverse events.

Summary: Although the majority of patients with diabetes are undergoing background statin therapy, which may mask potential adverse effects of PCSK9 inhibitors on glycaemic control, current data suggest that the benefits outweigh the risks for diabetic patients using PCSK9 inhibitors. Considering the different nature of genetic studies and of clinical trials, close monitoring of glucose parameters is necessary, especially in individuals with prediabetes.

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糖尿病患者使用 9 型蛋白转化酶枯草酶抑制剂的安全性如何?
综述的目的:研究糖尿病患者使用9型亚铁基转移酶抑制剂(PCSK9)的安全性,特别关注其对糖代谢的影响:糖尿病患者通常需要加强降脂治疗。PCSK9 抑制剂可将低密度脂蛋白胆固醇(LDL-C)浓度降低约 60%,在他汀类药物治疗的基础上还能显著降低心血管风险。一些研究表明,低密度脂蛋白胆固醇水平低与新发糖尿病风险增加之间存在关联,而遗传学几乎一致显示葡萄糖浓度和糖尿病风险增加。大多数临床试验并未显示糖尿病患者使用 PCSK9 抑制剂后血糖控制情况恶化,也不会导致其他重大治疗突发不良事件。小结:虽然大多数糖尿病患者正在接受背景他汀类药物治疗,这可能会掩盖 PCSK9 抑制剂对血糖控制的潜在不良影响,但目前的数据表明,糖尿病患者使用 PCSK9 抑制剂利大于弊。考虑到基因研究和临床试验的不同性质,有必要对血糖参数进行密切监测,尤其是对糖尿病前期患者。
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来源期刊
Current opinion in lipidology
Current opinion in lipidology 医学-内分泌学与代谢
CiteScore
6.70
自引率
4.50%
发文量
64
审稿时长
6-12 weeks
期刊介绍: With its easy-to-digest reviews on important advances in world literature, Current Opinion in Lipidology offers expert evaluation on a wide range of topics from six key disciplines including nutrition and metabolism, genetics and molecular biology, and hyperlipidaemia and cardiovascular disease. Published bimonthly, each issue covers in detail the most pertinent advances in these fields from the previous year. This is supplemented by a section of Bimonthly Updates, which deliver an insight into new developments at the cutting edge of the disciplines covered in the journal.
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