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Cordero A, Fernandez Olmo R, Santos-Gallego CG, Fácila L, Bonanad C, Castellano JM, Rodriguez-Mañero M, Seijas-Amigo J, González-Juanatey JR, Badimon JJ. Clinical Benefit of Bempedoic Acid in Randomized Clinical Trials. Am J Cardiol 2023; 205:321-324. [PMID: 37633067 DOI: 10.1016/j.amjcard.2023.07.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/25/2023] [Accepted: 07/30/2023] [Indexed: 08/28/2023]
Abstract
Bempedoic acid is a selective inhibitor of the adenosine triphosphate citrate lyase that reduces low-density lipoprotein cholesterol (LDLc) levels by 17% to 28%. Although the Evaluation of Major Cardiovascular Events in Patients With, or at High Risk for, Cardiovascular Disease Who Are Statin Intolerant Treated With Bempedoic Acid (CLEAR-OUTCOMES) trials demonstrated the efficacy on cardiovascular outcomes there is a controversy related to the possible net clinical benefit. Thereafter, we performed an intention-to-treat meta-analysis in line with recommendations from the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The primary outcome of the metanalysis was the incidence of major adverse cardiovascular events, defined by each study protocol. Secondary outcomes for the analyses were myocardial infarction, stroke, myocardial revascularization, cardiovascular death, and all-cause death. Results of 4 clinical trials evaluated contained a total of 17,324 patients; 9,236 received bempedoic acid for a median of 46.6 months. The mean baseline LDLc was 129.4 (22.8) mg/100 ml and treatment was associated with a mean LDLc reduction of 26.0 (12.6) mg/100 ml. Treatment with bempedoic acid significantly reduced the incidence of major adverse cardiovascular events (hazard ratio [HR] 0.88, 95% confidence interval [CI] 0.81 to 0.96), myocardial infarction (HR 0.76, 95% CI 0.66 to 0.89) and myocardial revascularization (HR 0.82, 95% CI 0.73 to 0.92); the crude incidence of stroke, cardiovascular or all-cause mortality were lower in patients in the bempedoic acid groups although no significant risk reduction was observed. No heterogeneity was observed in any of the end points. In conclusion, the metanalysis of the 4 clinical trials currently available with bempedoic acid provides reliable evidence of its clinical benefit with no signs of heterogeneity or harm.
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Affiliation(s)
- Alberto Cordero
- Cardiology Department, Hospital IMED Elche, Elche, Spain; Grupo de Investigación Cardiovascular (GRINCAVA), Universidad Miguel Hernández, Elche, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
| | | | - Carlos García Santos-Gallego
- Atherothrombosis Research Unit. Mount Sinai School of Medicine, New York, New York; Atherothrombosis Research Unit Mount Sinai Health, Icahn School of Medicine at Mount Siani, New York City, New York
| | - Lorenzo Fácila
- Cardiology Department, Hospital General, Valencia, Spain
| | - Clara Bonanad
- Cardiology Department, Hospital Clínico, Valencia, Spain
| | - José María Castellano
- Centro Integral de Enfermedades Cardiovasculares (CIEC), Hospital Universitario HM Monteprincipe, Grupo HM Hospitales, Madrid, Spain
| | - Moisés Rodriguez-Mañero
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Cardiology Department, Complejo Hospitalario de la Universidad de Santiago de Compostela, Santiago, Spain
| | - José Seijas-Amigo
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Cardiology Department, Complejo Hospitalario de la Universidad de Santiago de Compostela, Santiago, Spain
| | - José R González-Juanatey
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Cardiology Department, Complejo Hospitalario de la Universidad de Santiago de Compostela, Santiago, Spain
| | - Juan J Badimon
- Cardiology Department, Hospital General Jaen, Jaen, Spain; Atherothrombosis Research Unit. Mount Sinai School of Medicine, New York, New York
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Seijas-Amigo J, Salgado-Barreira Á, Castelo-Dominguez R, Pérez-Álvarez MT, Ponce-Piñón B, Fernández-Silva M, Rodríguez-Barreiro M, Pereira-Pía M, Iglesias-Moreno JM, Gago-García M, Montáns-García R, Fernandez-Perez A, FragaGayoso D, Fernandez-Montenegro M, Riveiro-Barciela B, Rilla-Villar N, Cordero A, RodríguezMañero M, González-Juanatey JR. Differences in weight loss and safety between the glucagon-like peptide-1 receptor agonists: A non-randomized multicenter study from the titration phase. Prim Care Diabetes 2023:S1751-9918(23)00095-5. [PMID: 37230813 DOI: 10.1016/j.pcd.2023.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/18/2023] [Accepted: 05/11/2023] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Obesity increases the risk of type 2 diabetes mellitus and cardiovascular disease (CVD). Weight loss (≥5 %) reduces the risk of CVD. Glucagon-like peptide-1 receptor agonists (GLP1 RA) have shown clinically weight loss. OBJECTIVES 1) To assess differences in the efficacy of weight loss and HbA1c; 2) to evaluate the safety and adherence during the titration phase. METHODS It is a multicenter, prospective, and observational study on GLP1 RA naïve patients. The primary end point was the weight loss (≥5 %). Changes in weight, BMI and HbA1c were also calculated as co-primary endpoints. Secondary endpoints were safety, adherence, and tolerance. RESULTS Among 94 subjects, 42.4 % received dulaglutide, 29,3 % subcutaneous semaglutide, 22,8 % oral semaglutide. 45 % female and the mean age was 62. Baseline characteristics were body weight 99.3 kg, BMI 36.7 kg/m2 and Hba1c 8.2 %. Oral semaglutide achieved the highest reduction: 61.1 % of patients achieving ≥ 5 %, subcutaneous semaglutide 45.8 % and dulaglutide 40.6 %. GLP1 RA significantly reduced body weight (-4.95 kg, p < 0.001) and BMI (-1.86 kg/m2, p < 0.001), without significant differences between groups. Gastrointestinal disorders were the most frequently reported events (74.5 %). 62 % of patients on dulaglutide, 25 % on oral semaglutide and 22 % on subcutaneous semaglutide. CONCLUSIONS Oral semaglutide achieved the highest proportion of patients that lost ≥ 5 %. GLP1 RA significantly reduced BMI and HbA1c. Most of the reported adverse events were gastrointestinal disorders and they were reported in a major frequency in the dulaglutide group. Oral semaglutide would be a reasonable switch in case of future shortages.
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Affiliation(s)
- José Seijas-Amigo
- Cardiology Department. Complejo Hospitalario Universidad de Santiago de Compostela, Santiago de Compostela, Spain; Fundación Instituto de Investigación Sanitaria de Santiago de Compostela (FIDIS), Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
| | - Ángel Salgado-Barreira
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain; Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud PúblicaCIBERESP), Carlos III Health Institute, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Alberto Cordero
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Cardiology Department. Hospital Universitario de San Juan, Alicante, Spain; Unidad de Investigación en Cardiología. Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), Spain
| | - Moisés RodríguezMañero
- Cardiology Department. Complejo Hospitalario Universidad de Santiago de Compostela, Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - José R González-Juanatey
- Cardiology Department. Complejo Hospitalario Universidad de Santiago de Compostela, Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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Cordero A, Fernández Olmo MR, Cortez Quiroga GA, Romero-Menor C, Fácila L, Seijas-Amigo J, Rondán Murillo J, Sandin M, Rodríguez-Mañero M, Bello Mora MC, Valle A, Fornovi A, Freixa Pamias R, Bañeras J, Blanch García P, Clemente Lorenzo MM, Sánchez-Álvarez S, López-Rodríguez L, González-Juanatey JR. Effect of PCSK9 inhibitors on remnant cholesterol and lipid residual risk: The LIPID-REAL registry. Eur J Clin Invest 2022; 52:e13863. [PMID: 36039486 DOI: 10.1111/eci.13863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/01/2022] [Accepted: 08/14/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Monoclonal antibodies that inhibit the proprotein convertase subtilisin/kexin type 9 (PCSK9) reduce low-density lipoprotein cholesterol (LDLc) by 55%, regardless of baseline treatments. Nonetheless, the effect of other lipid parameters, such as cholesterol remnants or, the so-called lipid residual risk, is unknown. METHODS Multicenter and retrospective registry of patients treated with PCSK9 inhibitors from 14 different hospitals in Spain. Before and on-treatment lipid parameters were recorded. Residual lipid risk was estimated by (1) cholesterol remnants, (2) triglycerides/HDLc ratio (TG/HDL), (3) total cholesterol/HDLc (TC/HDL) and (4) the triglycerides-to-glucose index (TGGi). RESULTS Six hundred fifty-two patients were analysed, mean age of 60.2 (9.63) years, 24.69% women and mean LDLc before treatment 149.24 (49.86) mg/dl. Median time to second blood determination was 187.5 days. On-treatment LDLc was 67.46 (45.78) mg/dl, which represented a 55% reduction. Significant reductions were observed for TG/HDL ratio, cholesterol remnants, TC/HDL ratio and TGGi. As consequence, 34.61% patients had LDLc <55 mg/dl and cholesterol remnants <30 mg/dl; additionally, 31.95% had cholesterol remnants <30 mg/dl but LDLc >55 mg/dl. Patients who had levels of cholesterol remnants >30 mg/dl before initiating the treatment with PCSK9 had higher reductions in cholesterol remnants, TG/HDL ratio, TC/HDL and TGGi. By contrast, no reduction differences were observed according to baseline LDLc (< or > the mean), age, gender or obesity. CONCLUSIONS This multicenter and retrospective registry of real-world patients treated with PCSK9 inhibitors demonstrates a positive effect on cholesterol remnants and lipid residual risk beyond LDLc reductions.
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Affiliation(s)
- Alberto Cordero
- Cardiology Department, Hospital Universitario de San Juan, Alicante, Spain.,Unidad de Investigación en Cardiología, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), Valencia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | | | | | - Cesar Romero-Menor
- Cardiology Department, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | - Lorenzo Fácila
- Cardiology Department, Consorcio Hospital General de Valencia, Valencia, Spain
| | - José Seijas-Amigo
- Cardiology Department, Complejo Hospitalario Universidad de Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Miriam Sandin
- Cardiology Department, Hospital General Universitario de Alicante, Alicante, Spain
| | - Moisés Rodríguez-Mañero
- Cardiology Department, Complejo Hospitalario Universidad de Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Alfonso Valle
- Cardiology Department, Hospital Universitario de Denia, Denia, Spain
| | - Aisa Fornovi
- Endocrinology Department, Hospital Vega Baja, Orihuela, Spain
| | - Roman Freixa Pamias
- Cardiology Department, Hospital Sant Joan Despí Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| | - Jordi Bañeras
- Cardiology Department, Hospital del Vall Hebrón, Barcelona, Spain
| | - Pedro Blanch García
- Cardiology Department, Hospital Sant Joan Despí Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| | | | | | | | - José R González-Juanatey
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Cardiology Department, Complejo Hospitalario Universidad de Santiago de Compostela, Santiago de Compostela, Spain
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Seijas-Amigo J, Salgado-Barreira Á, Castelo-Domínguez R, Pereira-Pía M, Rodríguez-Mañero M, González-Juanatey JR. Semaglutide versus GLP-1 agonists. Effectiveness, safety, and quality of life in patients with diabetes mellitus 2. The SEVERAL study. Farm Hosp 2022; 46:372-379. [PMID: 36520578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE The cardiovascular disease is the first cause of deaths in patients with diabetes mellitus 2. The objective is to evaluate and compare the weight loss in patients with diabetes treated with the different GLP-1 receptor agonists for the first time. Secondary endpoints are glycosylated hemoglobin reduction, changes in quality of life and physical activity and the safety of these drugs. METHOD It is a postauthorization, multicenter, non-randomized and prospective study. 360 Patients that will start treatment for the first time with GLP-1 receptor agonists will be recruited in 10 centers in the National Health System for a period of 6 months and 44 weeks of follow-up. The primary endpoint will be weight loss achieved with the different GLP-1 receptor agonists and the secondary endpoint will be glycosylated hemoglobin reduction, changes in the quality of life through the EuroQol‑5D and changes physical activity through the SF-12 questionnaire, and also the safety of these drugs. The estimate recruitment period will be 6 months, from 1 December 2021 to 1 May 2022. The follow up will finish in December 2022. DISCUSSION The SEVERAL study will try to provide information about weight loss efficacy, changes in quality of life, physical activity and safety of the GLP-1 receptor agonists in patients with diabetes that start treatment with these drugs in the real life. This study try to compare different GLP-1 receptor gonists in terms of effectiveness and safety for a better posterior election when these drugs are used in patients with diabetes mellitus 2 and obesity.
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Affiliation(s)
- José Seijas-Amigo
- Cardiology Department. Complexo Hospitalario Universitario de Santiago de Compostela, A Coruña. Spain. Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV). Fundación IDIS de Santiago de Compostela, A Coruña. Spain.
| | - Ángel Salgado-Barreira
- Unidad de Epidemiología e Investigación Clínica, Universidad de Santiago de Compostela, A Coruña. Spain. Pharmacy Department, Centro de Salud de Ribeira, A Coruña. Spain..
| | | | | | - Moisés Rodríguez-Mañero
- Cardiology Department. Complexo Hospitalario Universitario de Santiago de Compostela, A Coruña. Spain. Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)..
| | - José Ramón González-Juanatey
- Cardiology Department. Complexo Hospitalario Universitario de Santiago de Compostela, A Coruña. Spain. Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)..
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5
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Cordero A, Fernández Del Olmo MR, Cortez Quiroga GA, Romero-Menor C, Fácila L, Seijas-Amigo J, Fornovi A, Murillo JR, Rodríguez-Mañero M, Bello Mora MC, Valle A, Miriam S, Pamias RF, Bañeras J, García PB, Clemente Lorenzo MM, Sánchez-Alvarez S, López-Rodríguez L, González-Juanatey JR. Sex Differences in Low-Density Lipoprotein Cholesterol Reduction With PCSK9 Inhibitors in Real-world Patients: The LIPID-REAL Registry. J Cardiovasc Pharmacol 2022; 79:523-529. [PMID: 34983910 DOI: 10.1097/fjc.0000000000001205] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 11/24/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Previous evidence supports that monoclonal antibodies that inhibit the proprotein convertase subtilisin/kexin type 9 (PCSK9) reduce low-density lipoprotein cholesterol (LDLc) by 50%-65%, regardless of baseline treatments. We tested possible sex differences in a multicentre registry of real-world patients treated with PCSK9 inhibitors. METHODS This is a multicentre and retrospective study of 652 patients initiating treatment with any PCSK9 inhibitor in 18 different hospitals. Before-treatment and on-treatment LDLc and medical treatments, clinical indication, and clinical features were recorded. RESULTS Women represented 24.69% of the cohort. The use of statins was similar in both sexes, but women were receiving most frequently ezetimibe. Before-treatment median LDLc was 135 (interquartile range 115-166) mg, and it was higher in women. The median on-treatment LDLc was 57 (interquartile range 38-84) mg/dL, which represented a mean 54.5% reduction. On-treatment LDLc was higher in women, and the mean LDLc reduction was lower in women (47.4% vs. 56.9%; P = 0.0002) receiving evolocumab or alirocumab. The percentage of patients who achieved ≥50% LDLc reduction was higher in men (71.36% vs. 57.62%; P = 0.002). According to LDLc before-treatment quartiles, LDLc reduction was statistically lower in women in the 2 highest and a significant interaction of women and baseline LDLc >135 mg/dL was observed. Women were negatively associated with lower rates of LDLc treatment target achievement (odds ratio: 0.31). Differences were also observed in women with body mas index >25 kg/m2. Only 14 patients (2.14%) presented side effects. CONCLUSIONS This multicentre and retrospective registry of real-world patients treated with PCSK9 inhibitors highlights significant gender differences in LDLc reduction.
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Affiliation(s)
- Alberto Cordero
- Cardiology Department, Hospital Universitario de San Juan, Alicante, Spain
- Unidad de Investigación en Cardiología, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), Comunidad Valenciana, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | | | | | - Cesar Romero-Menor
- Cardiology Department, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | - Lorenzo Fácila
- Cardiology Department, Consorcio Hospital General de Valencia, Valencia, Spain
| | - José Seijas-Amigo
- Cardiology Department, Complejo Hospitalario Universidad de Santiago de Compostela, Santiago de Compostela, Spain
| | - Aisa Fornovi
- Endocrinology Department, Hospital Vega Baja, Orihuela, Spain
| | - Juan R Murillo
- Cardiology Department, Hospital Universitario de Cabueñes, Gijón, Spain
| | - Moisés Rodríguez-Mañero
- Cardiology Department, Complejo Hospitalario Universidad de Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Alfonso Valle
- Cardiology Department, Hospital Universitario de Denia, Denia, Spain
| | - Sandin Miriam
- Cardiology Department, Hospital General Universitario de Alicante, Alicante, Spain
| | - Roman F Pamias
- Cardiology Department, Hospital Sant Joan Despí Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| | - Jordi Bañeras
- Cardiology Department, Hospital del Vall Hebrón, Barcelona, Spain
| | - Pedro B García
- Cardiology Department, Hospital Sant Joan Despí Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| | | | | | | | - José R González-Juanatey
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Cardiology Department, Complejo Hospitalario Universidad de Santiago de Compostela, Santiago de Compostela, Spain
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Seijas-Amigo J, Rodríguez-Penas D, Estany-Gestal A, Suárez-Artime P, Santamaría-Cadavid M, González-Juanatey JR. Observational multicentre prospective study to assess changes in cognitive function in patients treated with PCSK9i. Study protocol. Farm Hosp 2021; 45:150-154. [PMID: 33941059 DOI: 10.7399/fh.11569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023] Open
Abstract
OBJECTIVE PCSK9 inhibitors have been shown to reduce LDLc by up to about 60% and 85% when used with high doses of statins and ezetimibe (2019 ESC/EAS Guidelines). These therapies may lead to very low levels of LDLc and have been associated with possible cognitive deterioration. No significant differences were found in the only specific study (EBBINGHAUS). The objective is to prospectively evaluate cognitive deterioration and its repercussion on quality of life and changes in LDLc in patients starting treatment with PCKS9 inhibitors. METHOD It is a postauthorization, multicentre, non-randomized, prospective study. Patients starting treatment for the first time with PCSK9 inhibitors will be recruited in 11 Galician Hospitals over a period of 12 months and with 24 months of follow-up. The primary outcome will be to evaluate changes in cognitive function using the Montreal Cognitive Assessment (MOCA) questionnaire. The secondary outcome will be to evaluate changes in quality of life using the EuroQol-5D. Changes in LDLc will be assessed. The sample size will be 275 patients, taking into account a loss to follow-up of no more than 10%. The primary outcome will be studied through the dichotomous variable cognitive deterioration (0/1). Cognitive changes over the follow-up period will be analysed using the McNemar test. In addition, an analytical approach using logistic regression will be followed to identify patients at risk of cognitive deterioration. As a result, this analysis will obtain a frequency measurement: the odds ratio (OR). The specific objectives will be studied using bivariate analysis. Continuous contrast variables will be studied using the t-test or ANOVA and categorical variables will be studied using the chi- square test. CONCLUSIONS The MEMOGAL study will provide information on safety in terms of cognitive deterioration in patients starting treatment with PCSK9 inhibitors.
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Affiliation(s)
- José Seijas-Amigo
- Servicio de Cardiología, Complexo Hospitalario Universitario de Santiago de Compostela (A Coruña). Spain..
| | - Diego Rodríguez-Penas
- Servicio de Cardiología, Complexo Hospitalario Universitario de Santiago de Compostela (A Coruña). Spain..
| | - Ana Estany-Gestal
- FIDIS-Unidad de Epidemiología e Investigación Clínica, Santiago de Compostela (A Coruña). Spain..
| | - Pedro Suárez-Artime
- Servicio de Farmacia, Complexo Hospitalario Universitario de Santiago de Compostela (A Coruña). Spain..
| | - María Santamaría-Cadavid
- Servicio de Neurología, Complexo Hospitalario Universitario de Santiago de Compostela (A Coruña). Spain..
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7
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Cordero A, Rodríguez-Mañero M, Fácila L, Fernández-Olmo MR, Gómez-Martínez MJ, Valle A, Castellano JM, Toro MM, Seijas-Amigo J, Vicedo A, González-Juanatey JR. Prevention of myocardial infarction and stroke with PCSK9 inhibitors treatment: a metanalysis of recent randomized clinical trials. J Diabetes Metab Disord 2020; 19:759-765. [PMID: 33520801 DOI: 10.1007/s40200-020-00557-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/18/2020] [Accepted: 05/26/2020] [Indexed: 12/11/2022]
Abstract
Purpose Proprotein convertase subtilisin/kexin 9 (PCSK9) inhibitors treatment induce large reductions in low-density lipoprotein cholesterol (LDLc) and major cardiovascular events. Clinical trials might have been underpowered to test the effect of PSCK9 inhibitors treatment on myocardial infarction and stroke, two of the most relevant cardiovascular events, since all analyzed a combined endpoint. Methods we performed a meta-analysis, with currently available studies involving PCSK9 inhibitors and event rate adjudication, with the aim of assessing treatment effects on myocardial infarction and stroke. Results We included 81,700 patients, 41,979 treated with a PSCK9 inhibitors: 17,244 with evolocumab; 13,720 with bococizumab and 11,015 with alirocumab. A total of 1,319 cases of myocardial infarctions were registered in the treatment group vs. 1,608 in controls, resulting in 19.0% reduction associated with PCSK9 treatment (RR: 0.81, 95% CI 0.76-0.87). Similarly, PCSK9 inhibitors treatment resulted in a 25% reduction of stroke (RR: 0.75, 95% CI 0.65-0.85) when all studies were analyzed together and the statistically significant heterogeneity was not observed in the analysis restricted to end-point based clinical trials. PCSK9 inhibitors treatment had no effect on mortality (RR: 0.95, 95% CI 0.86-1.04). Conclusions PCSK9 inhibitors reduce the incidence of myocardial infarction by 19% and stroke by 25%.
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Affiliation(s)
- Alberto Cordero
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Cardiology Department, Hospital Universitario de San Juan, Carretera Valencia-Alicante sn, San Juan de Alicante, 03550 Spain
| | - Moisés Rodríguez-Mañero
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Cardiology Department, Complejo Hospital Universitario de Santiago, Santiago de Compostela, Spain
| | - Lorenzo Fácila
- Cardiology Department, Hospital General Universitario de Valencia, Valencia, Spain
| | | | | | - Alfonso Valle
- Cardiology Department, Hospital de Denia, Denia, Spain
| | - Jose Mª Castellano
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Cardiology Department, Hospitales de Madrid, Madrid, Spain
| | | | - José Seijas-Amigo
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Cardiology Department, Complejo Hospital Universitario de Santiago, Santiago de Compostela, Spain
| | - Alvaro Vicedo
- Cardiology Department, Hospital de Denia, Denia, Spain
| | - José R González-Juanatey
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Cardiology Department, Complejo Hospital Universitario de Santiago, Santiago de Compostela, Spain
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