Masson W, Siniawski D, Lobo M, Molinero G, Giorgi M, Huerín M. Association between LDL-C, non HDL-C, and Apolipoprotein B levels with coronary plaque regression. The findings were similar in the stratified analysis according to the lipid-lowering drug class (ezetimibe or PCSK9 inhibitors). The dual therapy was used to investigate whether the additional decrease in LDL-C or non-HDL-C was associated with a regression in the volume of atheroma in the evaluated studies. These data suggests the addition of ezetimibe or PCSK9 inhibitors to statin therapy results in a significant regression of TAV. Virtual histology evaluation of atherosclerosis regression during atorvastatin and ezetimibe administration: HEAVEN study. The following are key points to remember about the 2017 Focused Update of the 2016 American College of Cardiology (ACC) Expert Consensus Decision Pathway on the Role of Non-Statin Therapies for Low-Density Lipoprotein (LDL)-Cholesterol Lowering in the Management of Atherosclerotic Cardiovascular Disease (ASCVD) Risk: Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Lipid Metabolism, Nonstatins, Novel Agents, Primary Hyperlipidemia, Statins, Keywords: Atherosclerosis, Cardiovascular Diseases, Cholesterol, Cholesterol, LDL, Consensus, Decision Making, Diabetes Mellitus, Dyslipidemias, Genetic Diseases, Inborn, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Hyperlipoproteinemia Type II, Life Style, Lipids, Lipid Metabolism, Inborn Errors, Lipoproteins, Patient Compliance, Primary Prevention, Proprotein Convertases, Risk Assessment, Risk Factors, Risk Reduction Behavior, Secondary Prevention, Subtilisins. In this meta-analyses, dual lipid-lowering treatment (statin plus ezetimibe or PCSK9 inhibitors) compared with statin monotherapy was associated with greater reduction in TAV. N Engl J Med. Dr. Luis Gutniski 3200, 3600, Formosa, Argentina, You can also search for this author in The lack of a statistically significant difference in the primary efficacy endpoint observed in this study needs to be considered in light of several specific factors of the study design, such as the limited sample size and the short duration of treatment period. Global and subgroup drug analysis. In the stratified analysis according to the lipid-lowering drug class, the findings were similar: (1) ezetimibe group: [− 4.0 mm3 (CI 95% -6.5 to − 1.5)]; P = 0.0018; I2 = 18%]; (2) PCSK9 inhibitor group: [− 3.9 mm3 (CI 95% -6.0 to − 1.7)]; P < 0.0001; I2 = 0%] Fig. Bukoh MX, Siah C-JR. A systematic review and meta-analysis on the structured handover interventions in improving patient safety outcomes. Taylor F, Huffman MD, Macedo AF, Moore THM, Burke M, Davey Smith G, et al. The role of ezetimibe in atherosclerosis regression was initially uncertain. Int Heart J. 2017 Focused Update of the 2016 ACC Expert Consensus Decision Pathway on the Role of Non-Statin Therapies for LDL-Cholesterol Lowering in the Management of Atherosclerotic Cardiovascular Disease Risk: A Report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways. The non-HDL-C comprises cholesterol carried by all potentially atherogenic particles, is simpler, more convenient and more predictive than LDL-C . Statins play a role in plaque regression with reduction in lipid content. 2018;66:70–2. Nicholls SJ, Ballantyne CM, Barter PJ, Chapman MJ, Erbel RM, Libby P, et al. The summary effect of non-statin lipid- lowering drugs on the TAV was estimated. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA, et al. PubMed Google Scholar. Moreover, it didn’t evaluate non-statin drugs such as PCSK9 inhibitors. CAS However, to assess the relationship between differences in LDL-C and non-HDL-C reduction and variations in mean difference of atheroma volume, a mixed-effects meta-regression model was performed. b Summary bias assessment of included studies. These medications stabilize atherosclerotic plaque with thickened fibrous layers and macrocalcification . High Blood Press Cardiovasc Prev. Int J Cardiol. JAMA. Future lipid lowering drugs should also demonstrate their impact on the regression of atherosclerosis. The writing committee recommended monitoring lipids at 4-12 weeks after modification to LDL-lowering therapy, including the addition of a non-statin therapy. The GLAGOV trial reported the effectiveness of the PCSK9 inhibitor (evolocumab) compared with statin alone, on plaque regression at the LDL-C level of 36 mg/dL, further confirming “the lower the better” theory . The data in the current paper are publicly available since this a meta-analysis conducted on the basis of the cited literature. The process of plaque regression by aggressive LDL-C and non-HDL-C lowering therapy with non-statin drugs can occur. 2015;105:11–9. Google Scholar. PubMed Central Statins for the primary prevention of cardiovascular disease. 2004;110:1061–8. Statistical analyses were performed using the R software for statistical computing version 3.5.1 with additional specific packages . This led to questioning the impact of these drugs on systemic inflammation . Part of Del Pinto R, Grassi D, Properzi G, Desideri G, Ferri C. Low density lipoprotein (LDL) cholesterol as a causal role for atherosclerotic disease: potential role of PCSK9 inhibitors. Nissen SE, Nicholls SJ, Sipahi I, Libby P, Raichlen JS, Ballantyne CM, et al. This meta-analysis presents several limitations. The ODYSSEY J-IVUS trials showed that alirocumab treatment over 36 weeks resulted in a numerically greater but not statistically significant percentage reduction in TAV . Three studies included patients with chronic coronary heart disease (HEAVEN, Masuda et al., GLAGOV) and other four studies evaluated subjects after an acute coronary syndrome (OCTIVUS, ZEUS, Hibi et al., ODYSSEY-J). Wan X, Wang W, Liu J, Tong T. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. Similarly, PCSK9 inhibitors are new pharmacologic agents that have an incremental effect on lowering LDL-C in statin-treated patients, combined with an excellent safety profile . Google Scholar. Seven studies were randomized and all of the trials evaluated had a control arm. Effect of rosuvastatin on coronary atheroma in stable coronary artery disease: multicenter coronary atherosclerosis study measuring effects of rosuvastatin using intravascular ultrasound in Japanese subjects (COSMOS). Analysis of publication bias: A funnel plot using the standard error (SE) for mean difference was created, and Begg and Mazumdar rank correlation were also performed. Addition of either ezetimibe or a PCSK9 inhibitor should also factor in patient preferences, costs, and route of administration in addition to percent of LDL lowering desired.
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