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Comparative effects of different antiplatelet strategies in carriers of CYP2C19 loss-of-function alleles: a network meta-analysis. 不同抗血小板策略对 CYP2C19 功能缺失等位基因携带者的比较效应:一项网络荟萃分析。
IF 5.3 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-04 DOI: 10.1093/ehjcvp/pvae036
Mattia Galli, Giovanni Occhipinti, Stefano Benenati, Renzo Laborante, Luis Ortega-Paz, Francesco Franchi, Domenico D'Amario, Roberto Nerla, Fausto Castriota, Giacomo Frati, Giuseppe Biondi-Zoccai, Sebastiano Sciarretta, Dominick J Angiolillo

Background: Carriers of cytochrome 2C19 (CYP2C19) loss-of-function (LoF) alleles treated with clopidogrel have impaired drug metabolism, resulting in reduced active metabolite levels, high platelet reactivity (HPR), and an increased risk of thrombotic events. Several alternative antiplatelet therapies have been proposed to overcome HPR in these patients, but their comparative effects remain poorly explored.

Methods: Randomized controlled trials (RCTs) comparing different oral antiplatelet therapies in carriers of CYP2C19 LoF alleles undergoing percutaneous coronary interventions (PCI) were included. A frequentist network meta-analysis was conducted to estimate mean difference (MD) or odds ratios and 95% confidence intervals (CI). The primary outcome was platelet reactivity assessed by VerifyNow and reported as P2Y12 reaction unit (PRU). The secondary outcome was the rate of HPR. Standard dose of clopidogrel (75 mg daily) was used as a reference treatment.

Results: A total of 12 RCTs testing 6 alternative strategies (i.e. clopidogrel 150 mg, prasugrel 3.75 mg, 5 mg, and 10 mg, ticagrelor 90 mg bid, and adjunctive cilostazol 100 mg bid) were included in the network. Compared with standard-dose clopidogrel, the greatest reduction in PRU was observed with prasugrel 10 mg (MD -127.91; 95% CI -141.04; -114.78) and ticagrelor 90 mg bid (MD -124.91; 95% CI -161.78; -88.04), followed by prasugrel 5 mg (MD -76.33; 95% CI -98.01; -54.65) and prasugrel 3.75 mg (MD -73.00; 95% CI -100.28; -45.72). Among other strategies, adjunctive cilostazol (MD -42.64; 95% CI -64.72; -20.57) and high-dose clopidogrel (MD -32.11; 95% CI -51.33; -12.90) were associated with a modest reduction in PRU compared with standard-dose clopidogrel.

Conclusion: Among carriers of CYP2C19 LoF alleles undergoing PCI, standard-dose prasugrel or ticagrelor are most effective in reducing platelet reactivity, while double-dose clopidogrel and additional cilostazol showed modest effects. Reduced-dose of prasugrel may represent a balanced strategy to overcome HPR without a significant increase in bleeding. The clinical implications of these pharmacodynamic findings warrant further investigation.

背景:细胞色素 2C19(CYP2C19)功能缺失(LoF)等位基因携带者在使用氯吡格雷治疗时,药物代谢会受损,导致活性代谢物水平降低、血小板反应性高(HPR)以及血栓事件风险增加。目前已提出了几种替代抗血小板疗法来克服这些患者的高血小板反应性,但对它们的比较效果仍缺乏深入探讨:方法:纳入了在接受经皮冠状动脉介入治疗(PCI)的 CYP2C19 LoF 等位基因携带者中比较不同口服抗血小板疗法的随机对照试验(RCT)。进行了频数网络荟萃分析,以估计平均差(MD)或几率比(OR)和95%置信区间(CI)。主要结果是由 VerifyNow 评估的血小板反应性,并以 P2Y12 反应单位 (PRU) 报告。次要结果是 HPR 发生率。标准剂量的氯吡格雷(每天 75 毫克)作为参考治疗:该网络共纳入了 12 项 RCT,测试了 6 种替代策略(即氯吡格雷 150 毫克、普拉格雷 3.75 毫克、5 毫克和 10 毫克、替卡格雷 90 毫克 bid 和辅助西洛他唑 100 毫克 bid)。与标准剂量氯吡格雷相比,普拉格雷 10 mg(MD -127.91; 95% CI -141.04; -114.78)和替卡格雷 90 mg bid(MD -124.91;95% CI -161.78;-88.04),其次是普拉格雷 5 毫克(MD -76.33;95% CI -98.01;-54.65)和普拉格雷 3.75 毫克(MD -73.00;95% CI -100.28;-45.72)。在其他策略中,与标准剂量氯吡格雷相比,辅助西洛他唑(MD-42.64;95% CI -64.72;-20.57)和大剂量氯吡格雷(MD -32.11;95% CI -51.33;-12.90)与PRU的适度降低有关:结论:在接受PCI治疗的CYP2C19 LoF等位基因携带者中,标准剂量的普拉格雷或替卡格雷能最有效地降低血小板反应性,而双倍剂量的氯吡格雷和额外的西洛他唑效果一般。减少剂量的普拉格雷可能是克服 HPR 的一种平衡策略,同时不会显著增加出血量。这些药效学发现的临床意义值得进一步研究。
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引用次数: 0
CYP2C19 genetic testing for Mavacamten and ischaemic stroke treatment: What does the result mean for cardiovascular prescribers in the UK and Europe? 针对马伐康坦和缺血性中风治疗的 CYP2C19 基因检测:该结果对英国和欧洲的心血管处方者意味着什么?
IF 5.3 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-04 DOI: 10.1093/ehjcvp/pvae040
Emma F Magavern, John H McDermott, Mark J Caulfield, William G Newman
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引用次数: 0
All about clinical trials. 关于临床试验
IF 5.3 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-04 DOI: 10.1093/ehjcvp/pvae055
Anne Grete Semb, Julie Sanders, Juan Carlos Kaski
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引用次数: 0
Pharmacological management of transthyretin amyloid cardiomyopathy: a scoping review. 转甲状腺素淀粉样变性心肌病的药物治疗:范围综述。
IF 5.3 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-04 DOI: 10.1093/ehjcvp/pvae044
Shafi Rehman, Shameera Shaik Masthan, Ramzi Ibrahim, Hoang Nhat Pham, Danial Hassan, Fahad Ahmad, Mohammad Shahzad Asif, Ahmad Safdar, Zain Anwar, Shahzad Raza, Preethi William

Aims: Transthyretin amyloid cardiomyopathy (ATTR-CM) is characterized by the accumulation of transthyretin (TTR) protein in the myocardium. The aim of this scoping review is to provide a descriptive summary of the clinical trials and observational studies that evaluated the clinical efficacy and safety of various agents used in ATTR-CM, with a goal of identifying the contemporary gaps in literature and to reveal future research opportunities.

Methods and results: The search was performed in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A literature search using several databases for observational and clinical trials investigating the treatment modalities for ATTR-CM was undertaken. We extracted data including study characteristics, primary endpoints, and adverse events from each study. A total of 19 studies were included in our scoping review. Out of which, 8 were clinical trials and 11 were observational analyses. The drugs evaluated included tafamadis, acoramidis, revusiran, doxycycline and tauroursodeoxycholic acid and doxycycline, diflusinil, inotersan, eplontersen, and patisiran. Tafamidis has shown to be efficacious in the management of ATTR-CM, particularly when initiated at earlier stages. RNA interference and antisense oligonucleotide drugs have shown promising impacts on quality of life. Additionally, this review identified gaps in the literature, particularly among long-term outcomes, comparative effectiveness, and the translation of research into economic contexts.

Conclusion: Multiple pharmacological options are potential disease-modifying therapies for ATTR-CM. However, many gaps exist in the understanding of these various drug therapies, warranting further research. The future directions for management of ATTR-CM are promising in regard to improving prognostic implications.

目的:转甲状腺素淀粉样变性心肌病(ATTR-CM)的特征是转甲状腺素(TTR)蛋白在心肌中的蓄积。本范围综述旨在对评估用于 ATTR-CM 的各种药物的临床疗效和安全性的临床试验和观察性研究进行描述性总结,目的是找出文献中的当代空白,并揭示未来的研究机会:检索按照《系统综述和元分析首选报告项目》(PRISMA)指南进行。我们使用多个数据库对研究 ATTR-CM 治疗方法的观察性和临床试验进行了文献检索。我们从每项研究中提取了包括研究特征、主要终点和不良事件在内的数据。共有 19 项研究纳入了我们的范围界定审查。其中 8 项为临床试验,11 项为观察性分析。接受评估的药物包括他法米迪、阿可拉米迪、雷夫西兰、TUDCA 和强力霉素、地氟西尼、依诺他桑、依普隆特生和帕替西兰。他法米迪对治疗 ATTR-CM 有一定疗效,尤其是在早期阶段。RNA 干扰和反义寡核苷酸药物已显示出对生活质量的良好影响。此外,本综述还发现了文献中的不足之处,尤其是在长期疗效、比较效果以及将研究成果转化为经济效益方面:结论:多种药物选择是治疗 ATTR-CM 的潜在疾病改变疗法。结论:多种药物疗法是治疗 ATTR-CM 的潜在疾病改变疗法,但对这些不同药物疗法的认识还存在许多差距,需要进一步研究。未来 ATTR-CM 的治疗方向有望改善预后影响。
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引用次数: 0
Association of PCSK9 inhibitors with mortality: insights from a retrospective cohort analysis. PCSK9 抑制剂与死亡率的关系:回顾性队列分析的启示。
IF 5.3 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-04 DOI: 10.1093/ehjcvp/pvae056
Chi-Hsien Huang, Shiow-Ing Wang, Frank S Fan, Hsueh-Ju Lu, James Cheng-Chung Wei

Aims: Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors are effective in reducing cardiovascular events, but their impact on all-cause mortality and medical utilization compared to statins is unclear. This study investigated PCSK9 inhibitor use and its impact on mortality and medical utilization vs. statins, using TriNetX database data with up to 9 years of follow-up.

Methods and results: This retrospective cohort study analysed TriNetX data spanning 1 July 2015, to 31 December 2023, including 79 194 PCSK9 inhibitor users (alirocumab, evolocumab, inclisiran) and 5 437 513 statin users with hyperlipidaemia. The primary outcomes were all-cause mortality and medical utilization, including hospital inpatient services, emergency department visits, critical care, and mechanical ventilation. Propensity score matching showed that PCSK9 inhibitor use was associated with a 28.3% lower risk of all-cause mortality [adjusted hazard ratio (aHR) 0.717, 95% confidence interval (CI): 0.673-0.763] and significant reductions in medical utilization (hospital inpatient services usage: aHR 0.692, 95% CI: 0.664-0.721; emergency department services: aHR 0.756, 95% CI: 0.726-0.788; critical care services: aHR 0.619, 95% CI: 0.578-0.664; and mechanical ventilation: aHR 0.537, 95% CI: 0.484-0.596) compared to statins. These findings were consistent across various demographics and clinical subgroups. The sensitivity analyses supported the robustness of the findings.

Conclusion: PCSK9 inhibitors significantly reduced all-cause mortality and medical utilization compared to statins, suggesting their important role in dyslipidaemia management, particularly for statin-naïve or intolerant patients. Further research, including randomized controlled trials, is needed to confirm these findings and explore the underlying mechanisms.

背景和目的:PCSK9 抑制剂可有效减少心血管事件,但与他汀类药物相比,其对全因死亡率和医疗利用率的影响尚不明确。本研究利用随访长达 9 年的 TriNetX 数据库数据,调查了 PCSK9 抑制剂的使用情况及其对死亡率和医疗利用率的影响:这项回顾性队列研究分析了2015年7月1日至2023年12月31日的TriNetX数据,其中包括79 194名PCSK9抑制剂使用者(阿利珠单抗、依维莫单抗、clisiran)和5 437 513名他汀类药物高脂血症使用者。主要结果是全因死亡率和医疗使用率,包括住院服务、急诊就诊、重症监护和机械通气。倾向得分匹配显示,使用 PCSK9 抑制剂可使全因死亡风险降低 28.3%(调整后危险比 [aHR] 0.717,95% CI:0.673-0.763),并显著降低医疗使用率(住院病人服务使用率:aHR 0.692,95% CI:0.664-0.721;急诊科服务:aHR 0.756,95% CI:0.726-0.788;重症监护服务:aHR 0.619,95% CI:0.578-0.664;机械通气:aHR 0.537,95% CI:0.484-0.596)。这些结果在不同的人口统计学和临床亚组中是一致的。敏感性分析证实了研究结果的稳健性:结论:与他汀类药物相比,PCSK9抑制剂能明显降低全因死亡率和医疗使用率,这表明它在血脂异常管理中发挥着重要作用,尤其是对他汀类药物无效或不耐受的患者。需要进一步研究,包括随机对照试验,以证实这些发现并探索其潜在机制。
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引用次数: 0
Focus on different lipid-lowering treatment and genetic testing for optimal pharmacotherapy use in the clinic. 重点关注不同的降脂治疗和基因检测,以便在临床中优化药物疗法的使用。
IF 5.3 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-04 DOI: 10.1093/ehjcvp/pvae061
Stefan Agewall
{"title":"Focus on different lipid-lowering treatment and genetic testing for optimal pharmacotherapy use in the clinic.","authors":"Stefan Agewall","doi":"10.1093/ehjcvp/pvae061","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvae061","url":null,"abstract":"","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":"10 6","pages":"479-480"},"PeriodicalIF":5.3,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142371349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Effects of icosapent ethyl according to baseline residual risk in patients with atherosclerotic cardiovascular disease: results from REDUCE-IT. 根据动脉粥样硬化性心血管疾病患者的基线残余风险确定冰沙平乙酯的效果:REDUCE-IT 的结果。
IF 5.3 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-04 DOI: 10.1093/ehjcvp/pvae030
Pascal M Burger, Deepak L Bhatt, Jannick A N Dorresteijn, Stefan Koudstaal, Arend Mosterd, Fabrice M A C Martens, Philippe Gabriel Steg, Frank L J Visseren

Aims: Icosapent ethyl lowers triglycerides and significantly reduces major adverse cardiovascular events (MACE), though treatment effects may vary between individuals. This study aimed to determine the relative and absolute effects of icosapent ethyl on MACE according to baseline cardiovascular disease (CVD) risk in patients with atherosclerotic cardiovascular disease (ASCVD).

Methods and results: Participants from the Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial (REDUCE-IT) with ASCVD were included (n = 5785). The primary outcome was 3-point MACE, i.e. non-fatal myocardial infarction, non-fatal stroke, or cardiovascular death. Baseline 5-year risk of MACE was estimated using the European Society of Cardiology (ESC) guideline-recommended SMART2 risk score. Modification of the relative treatment effects of icosapent ethyl by baseline risk was assessed using Cox proportional hazards models, including a treatment-by-risk interaction. Next, treatment effects were assessed stratified by quartiles of baseline risk. During a median follow-up of 4.8 years (interquartile range 3.2-5.3), MACE occurred in 361 vs. 489 patients in the icosapent ethyl vs. placebo group [95% confidence interval (CI)]; hazard ratio (HR) 0.72 (0.63-0.82), absolute risk reduction (ARR) 4.4% (2.6-6.2%), number needed to treat (NNT) 23 (16-38), and 5-year Kaplan-Meier estimated cumulative incidence reduction (CIR) 5.7% (3.5-7.9%). Icosapent ethyl significantly reduced MACE in all risk quartiles, with an HR (95% CI) of 0.62 (0.43-0.88), 0.66 (0.48-0.92), 0.69 (0.53-0.90), and 0.78 (0.63-0.96), respectively (P for treatment-by-risk interaction = 0.106). The ARR (95% CI) increased across risk quartiles, i.e. was 3.9% (1.0-6.8%), 4.3% (1.2-7.3%), 5.1% (1.4-8.7%), and 5.6% (1.3-10.0%), respectively. This translates to NNTs (95% CI) of 26 (15-98), 24 (14-84), 20 (11-70), and 18 (10-77). The 5-year CIR (95% CI) was 4.8% (1.3-8.2%), 5.0% (1.3-8.7%), 6.1% (1.7-10.5%), and 7.7% (2.3-13.2%), respectively. Consistent results were obtained for 5-point MACE, additionally including coronary revascularization and unstable angina.

Conclusion: Among patients with ASCVD and elevated triglyceride levels, icosapent ethyl significantly reduces the risk of MACE irrespective of baseline CVD risk, though absolute benefits are largest for patients at the highest risk.

背景和目的:伊可新戊酯可降低甘油三酯并显著减少主要不良心血管事件(MACE),但治疗效果可能因人而异。本研究旨在根据动脉粥样硬化性心血管疾病(ASCVD)患者的基线心血管疾病风险,确定伊可新戊酯对 MACE 的相对和绝对影响:方法:纳入REDUCE-IT的ASCVD患者(n = 5,785)。主要结果为3点MACE,即非致死性心肌梗死、非致死性中风或心血管死亡。采用ESC指南推荐的SMART2风险评分估算基线5年MACE风险。使用包括治疗与风险交互作用的 Cox 比例危险模型评估了基线风险对 icosapent ethyl 相对治疗效果的影响。然后,根据基线风险的四分位数对治疗效果进行分层评估:在中位随访 4.8 年(四分位间范围 3.2-5.3)期间,伊可新乙酯组与安慰剂组分别有 361 例和 489 例患者发生 MACE(95% 置信区间 [CI]);危险比 (HR) 0.72 (0.63-0.82),绝对风险降低率 (ARR) 4.4% (2.6-6.2%),治疗所需人数 (NNT) 23 (16-38),5 年 Kaplan-Meier 估计累积发病率降低率 (CIR) 5.7% (3.5-7.9%)。在所有风险四分位数中,伊可新戊酯都能显著降低MACE,HR(95% CI)分别为0.62(0.43-0.88)、0.66(0.48-0.92)、0.69(0.53-0.90)和0.78(0.63-0.96)(治疗与风险的交互作用P=0.106)。ARR(95% CI)随风险四分位数的增加而增加,即分别为 3.9% (1.0-6.8%)、4.3% (1.2-7.3%)、5.1% (1.4-8.7%) 和 5.6% (1.3-10.0%)。这意味着NNTs(95% CI)分别为26(15-98)、24(14-84)、20(11-70)和18(10-77)。5 年 CIR(95% CI)分别为 4.8%(1.3-8.2%)、5.0%(1.3-8.7%)、6.1%(1.7-10.5%)和 7.7%(2.3-13.2%)。5点MACE结果一致,此外还包括冠状动脉血运重建和不稳定型心绞痛:结论:在患有 ASCVD 和甘油三酯水平升高的患者中,无论基线 CVD 风险如何,icosapent ethyl 均可显著降低 MACE 风险,但高风险患者的绝对获益最大。
{"title":"Effects of icosapent ethyl according to baseline residual risk in patients with atherosclerotic cardiovascular disease: results from REDUCE-IT.","authors":"Pascal M Burger, Deepak L Bhatt, Jannick A N Dorresteijn, Stefan Koudstaal, Arend Mosterd, Fabrice M A C Martens, Philippe Gabriel Steg, Frank L J Visseren","doi":"10.1093/ehjcvp/pvae030","DOIUrl":"10.1093/ehjcvp/pvae030","url":null,"abstract":"<p><strong>Aims: </strong>Icosapent ethyl lowers triglycerides and significantly reduces major adverse cardiovascular events (MACE), though treatment effects may vary between individuals. This study aimed to determine the relative and absolute effects of icosapent ethyl on MACE according to baseline cardiovascular disease (CVD) risk in patients with atherosclerotic cardiovascular disease (ASCVD).</p><p><strong>Methods and results: </strong>Participants from the Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial (REDUCE-IT) with ASCVD were included (n = 5785). The primary outcome was 3-point MACE, i.e. non-fatal myocardial infarction, non-fatal stroke, or cardiovascular death. Baseline 5-year risk of MACE was estimated using the European Society of Cardiology (ESC) guideline-recommended SMART2 risk score. Modification of the relative treatment effects of icosapent ethyl by baseline risk was assessed using Cox proportional hazards models, including a treatment-by-risk interaction. Next, treatment effects were assessed stratified by quartiles of baseline risk. During a median follow-up of 4.8 years (interquartile range 3.2-5.3), MACE occurred in 361 vs. 489 patients in the icosapent ethyl vs. placebo group [95% confidence interval (CI)]; hazard ratio (HR) 0.72 (0.63-0.82), absolute risk reduction (ARR) 4.4% (2.6-6.2%), number needed to treat (NNT) 23 (16-38), and 5-year Kaplan-Meier estimated cumulative incidence reduction (CIR) 5.7% (3.5-7.9%). Icosapent ethyl significantly reduced MACE in all risk quartiles, with an HR (95% CI) of 0.62 (0.43-0.88), 0.66 (0.48-0.92), 0.69 (0.53-0.90), and 0.78 (0.63-0.96), respectively (P for treatment-by-risk interaction = 0.106). The ARR (95% CI) increased across risk quartiles, i.e. was 3.9% (1.0-6.8%), 4.3% (1.2-7.3%), 5.1% (1.4-8.7%), and 5.6% (1.3-10.0%), respectively. This translates to NNTs (95% CI) of 26 (15-98), 24 (14-84), 20 (11-70), and 18 (10-77). The 5-year CIR (95% CI) was 4.8% (1.3-8.2%), 5.0% (1.3-8.7%), 6.1% (1.7-10.5%), and 7.7% (2.3-13.2%), respectively. Consistent results were obtained for 5-point MACE, additionally including coronary revascularization and unstable angina.</p><p><strong>Conclusion: </strong>Among patients with ASCVD and elevated triglyceride levels, icosapent ethyl significantly reduces the risk of MACE irrespective of baseline CVD risk, though absolute benefits are largest for patients at the highest risk.</p>","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":"488-499"},"PeriodicalIF":5.3,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140848203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Utilizing genetics and proteomics to assess the role of antihypertensive drugs in human longevity and the underlying pathways: a Mendelian randomization study. 利用遗传学和蛋白质组学评估降压药在人类长寿中的作用及其潜在途径:孟德尔随机研究。
IF 5.3 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-04 DOI: 10.1093/ehjcvp/pvae038
Bohan Fan, Jie V Zhao

Background: Antihypertensive drugs are known to lower cardiovascular mortality, but the role of different types of antihypertensive drugs in lifespan has not been clarified. Moreover, the underlying mechanisms remain unclear.

Methods and results: To minimize confounding, we used Mendelian randomization to assess the role of different antihypertensive drug classes in longevity and examined the pathways via proteins. Genetic variants associated with systolic blood pressure (SBP) corresponding to drug-target genes were used as genetic instruments. The genetic associations with lifespan were obtained from a large genome-wide association study including 1 million European participants from UK Biobank and LifeGen. For significant antihypertensive drug classes, we performed sex-specific analysis, drug-target analysis, and colocalization. To examine the mediation pathways, we assessed the associations of 2291 plasma proteins with lifespan, and examined the associations of drug classes with the proteins affecting lifespan. After correcting for multiple testing, genetically proxied beta-blockers (BBs), calcium channel blockers (CCBs), and vasodilators were related to longer life years (BBs: 2.03, 95% CI 0.78-3.28 per 5 mmHg reduction in SBP, CCBs: 3.40, 95% CI 1.47-5.33, and vasodilators: 2.92, 95% CI 1.08-4.77). The beneficial effects of BBs and CCBs were more obvious in men. ADRB1, CACNA2D2, CACNB3, CPT1A, CPT2, and EDNRA genes were related to extended lifespan, with CPT2 further supported by colocalization evidence. Eighty-six proteins were related to lifespan, of which four proteins were affected by CCBs. CDH1 may mediate the association between CCBs and lifespan.

Conclusions: Beta-blockers, CCBs, and vasodilators may prolong lifespan, with potential sex differences for BBs and CCBs. The role of CCBs in lifespan is partly mediated by CDH1. Prioritizing the potential protein targets can provide new insights into healthy aging.

背景:众所周知,降压药可降低心血管疾病死亡率,但不同类型的降压药在寿命中的作用尚未明确。此外,其潜在机制仍不清楚:为了最大限度地减少混杂因素,我们采用孟德尔随机法评估了不同类型的降压药对长寿的作用,并通过蛋白质研究了其作用途径。与药物靶基因相对应的收缩压(SBP)相关基因变异被用作遗传工具。与寿命相关的遗传变异来自一项大型全基因组关联研究,其中包括来自英国生物库和 LifeGen 的 100 万欧洲参与者。对于重要的抗高血压药物类别,我们进行了性别特异性分析、药物靶标分析和共定位分析。为了研究中介途径,我们评估了2291种血浆蛋白与寿命的关联,并研究了药物类别与影响寿命的蛋白的关联:经多重检验校正后,基因替代的β受体阻滞剂(BBs)、钙通道阻滞剂(CCBs)和血管扩张剂与延长寿命有关(BBs:SBP每降低5 mmHg,BBs的寿命为2.03,95% CI为0.78-3.28;CCBs:SBP每降低5 mmHg,CCBs的寿命为3.40,95% CI为1.28):3.40,95% CI 1.47 至 5.33,血管扩张剂:2.92,95% CI 1.08 至 4.77)。BB类和CCB类药物对男性的益处更为明显。ADRB1、CACNA2D2、CACNB3、CPT1A、CPT2和EDNRA基因与延长寿命有关,其中CPT2得到了共定位证据的进一步支持。86种蛋白质与寿命有关,其中4种蛋白质受CCB影响。CDH1可能介导了CCBs与寿命之间的关联:结论:BBs、CCBs和血管扩张剂可延长寿命,其中BBs和CCBs可能存在性别差异。CCBs对寿命的作用部分由CDH1介导。对潜在的蛋白质靶点进行优先排序可为健康老龄化提供新的见解。
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引用次数: 0
Does LDL-C determination method affect statin prescribing for primary prevention? A register-based study in Southern Denmark. 低密度脂蛋白胆固醇(LDL-C)的测定方法会影响他汀类药物的一级预防处方吗?一项基于丹麦南部登记册的研究。
IF 5.3 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-04 DOI: 10.1093/ehjcvp/pvae043
Anton Pottegård, Lars Ulrik Gerdes, Jakob Langballe Wetche, Wade Thompson

Aims: Examine whether the low-density lipoprotein cholesterol (LDL -C) determination method influences the rate of statin initiation for primary prevention of cardiovascular disease.

Methods and results: We conducted a register-based retrospective study in the Region of Southern Denmark. Two hospital-based laboratories in the region directly measure LDL -C whereas four laboratories calculate LDL -C using Friedewald's formula. Physicians do not choose which method is used. We included all statin-naïve patients ≥40 years with no history of cardiovascular disease, diabetes, or chronic kidney disease, who had their LDL -C determined during 2018-2019. There were 202 807 people who had LDL -C determined during the study period (median age 59 years, 44% women) of which 37% had a direct LDL -C measurement. The median reported LDL -C was 3.40 mmol/L [interquartile range (IQR) 2.90-4.00] for those with a direct measurement vs. 3.00 mmol/L (IQR 2.40-3.50) for those with calculated LDL -C. For those with direct measurement, re-calculated LDL -C (using Friedewald's formula) was 0.35 mmol/L lower than the reported direct LDL -C measurement. Among those with directly measured LDL -C, 3.6% initiated statins compared with 2.7% of those with a calculated LDL -C. Direct LDL -C measurement led to higher odds of having a statin initiated compared with calculated LDL -C (adjusted odds ratio 1.23, 95% CI 1.17-1.30); for those with triglycerides >1.7 mmol/L the adjusted odds ratio was 1.41 (95% CI 1.30-1.52).

Conclusion: Differences in the reporting of LDL -C from laboratories using different methods have a substantial influence on physician's decisions to prescribe statins.

目的:研究低密度脂蛋白胆固醇(LDL-C)的测定方法是否会影响他汀类药物在心血管疾病一级预防中的使用率:我们在南丹麦大区开展了一项基于登记的回顾性研究。该地区有两家医院实验室直接测量低密度脂蛋白胆固醇,有四家实验室使用弗里德瓦尔德公式计算低密度脂蛋白胆固醇。医生不能选择使用哪种方法。我们纳入了所有年龄≥40 岁、无心血管疾病、糖尿病或慢性肾病史、在 2018-2019 年期间测定过低密度脂蛋白胆固醇的他汀类药物无效患者。在研究期间,共有 202 807 人测定了低密度脂蛋白胆固醇(中位年龄为 59 岁,44% 为女性),其中 37% 直接测定了低密度脂蛋白胆固醇。直接测量者报告的低密度脂蛋白胆固醇中位数为 3.40 mmol/L(IQR 2.90 至 4.00),而计算得出的低密度脂蛋白胆固醇中位数为 3.00 mmol/L(IQR 2.40 至 3.50)。在直接测量的人群中,重新计算的低密度脂蛋白胆固醇(使用弗里德瓦尔德公式)比报告的直接低密度脂蛋白胆固醇测量值低 0.35 mmol/L。在直接测量低密度脂蛋白胆固醇的人群中,有 3.6% 的人开始服用他汀类药物,而在计算低密度脂蛋白胆固醇的人群中,只有 2.7% 的人开始服用他汀类药物。与计算出的 LDL-C 相比,直接测量出的 LDL-C 使开始服用他汀类药物的几率更高(调整后的几率比为 1.23,95% CI 为 1.17 至 1.30);甘油三酯大于 1.7 mmol/L 者的调整后几率比为 1.41(95% CI 为 1.30 至 1.52):结论:采用不同方法的实验室在报告低密度脂蛋白胆固醇方面的差异对医生开具他汀类药物处方的决定有很大影响。
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引用次数: 0
2024 ESC Guidelines on Chronic Coronary Syndromes: What is New in Pharmacotherapy? 2024 ESC 慢性冠状动脉综合征指南:药物疗法有何新进展?
IF 7.1 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-17 DOI: 10.1093/ehjcvp/pvae069
Mattia Galli,Felice Gragnano,Christiaan Vrints,Felicita Andreotti
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引用次数: 0
期刊
European Heart Journal - Cardiovascular Pharmacotherapy
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