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Apolipoprotein B, R...
Apolipoprotein B, Residual Cardiovascular Risk After Acute Coronary Syndrome, and Effects of Alirocumab
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- Hagström, Emil (författare)
- Uppsala universitet,Kardiologi,Uppsala kliniska forskningscentrum (UCR)
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- Steg, P. Gabriel (författare)
- Univ Paris, Hop Bichat, AP HP, Dept Cardiol,FACT French Alliance Cardiovasc Tria, Paris, France.;INSERM U1148, Paris, France.;Imperial Coll, Royal Brompton Hosp, London, England.
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- Szarek, Michael (författare)
- Univ Colorado, Sch Med, CPC Clin Res, Aurora, CO USA.;Univ Colorado, Sch Med, Div Cardiol, Aurora, CO USA.;SUNY Downstate Hlth Sci Univ, Brooklyn, NY USA.
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- Bhatt, Deepak L. (författare)
- Brigham & Womens Hosp, Heart & Vasc Ctr, Dept Med, 75 Francis St, Boston, MA 02115 USA.;Harvard Med Sch, Boston, MA 02115 USA.
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- Bittner, Vera A. (författare)
- Univ Alabama Birmingham, Div Cardiovasc Dis, Birmingham, AL 35294 USA.
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- Danchin, Nicolas (författare)
- Hop Europeen Georges Pompidou, AP HP, Dept Cardiol, Paris, France.;Univ Paris 05, Paris, France.
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- Diaz, Rafael (författare)
- Inst Cardiovasc Rosario, Estudios Cardiol Latino Amer, Rosario, Argentina.
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- Goodman, Shaun G. (författare)
- Univ Alberta, Canadian VIGOUR Ctr, Edmonton, AB, Canada.;Univ Toronto, St Michaels Hosp, Toronto, ON, Canada.
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- Harrington, Robert A. (författare)
- Stanford Univ, Stanford Ctr Clin Res, Dept Med, Stanford, CA 94305 USA.
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- Jukema, J. Wouter (författare)
- Leiden Univ, Med Ctr, Dept Cardiol, Leiden, Netherlands.;Netherlands Heart Inst, Utrecht, Netherlands.
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- Liberopoulos, Evangelos (författare)
- Natl & Kapodistrian Univ Athens, Sch Med, Athens, Greece.
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- Marx, Nikolaus (författare)
- Rhein Westfal TH Aachen, Univ Hosp, Aachen, Germany.
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- McGinniss, Jennifer (författare)
- Regeneron Pharmaceut Inc, 777 Old Saw Mill River Rd, Tarrytown, NY 10591 USA.
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- Manvelian, Garen (författare)
- Regeneron Pharmaceut Inc, 777 Old Saw Mill River Rd, Tarrytown, NY 10591 USA.
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- Pordy, Robert (författare)
- Regeneron Pharmaceut Inc, 777 Old Saw Mill River Rd, Tarrytown, NY 10591 USA.
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- Scemama, Michel (författare)
- Sanofi, Paris, France.
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- White, Harvey D. (författare)
- Auckland City Hosp, Green Lane Cardiovasc Serv, Auckland, New Zealand.;Auckland Univ, Auckland, New Zealand.
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- Zeiher, Andreas M. (författare)
- Goethe Univ, Dept Med 3, Frankfurt, Germany.
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- Schwartz, Gregory G. (författare)
- Univ Colorado, Sch Med, Div Cardiol, Aurora, CO USA.
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(creator_code:org_t)
- Ovid Technologies (Wolters Kluwer Health), 2022
- 2022
- Engelska.
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Ingår i: Circulation. - : Ovid Technologies (Wolters Kluwer Health). - 0009-7322 .- 1524-4539. ; 146:9, s. 657-672
- Relaterad länk:
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https://doi.org/10.1...
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https://uu.diva-port... (primary) (Raw object)
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
Ämnesord
Stäng
- BACKGROUND: Apolipoprotein B (apoB) provides an integrated measure of atherogenic risk. Whether apoB levels and apoB lowering hold incremental predictive information on residual risk after acute coronary syndrome beyond that provided by low-density lipoprotein cholesterol is uncertain. METHODS: The ODYSSEY OUTCOMES trial (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab) compared the proprotein convertase subtilisin/kexin type 9 inhibitor alirocumab with placebo in 18 924 patients with recent acute coronary syndrome and elevated atherogenic lipoproteins despite optimized statin therapy. Primary outcome was major adverse cardiovascular events (MACE; coronary heart disease death, nonfatal myocardial infarction, fatal/nonfatal ischemic stroke, hospitalization for unstable angina). Associations between baseline apoB or apoB at 4 months and MACE were assessed in adjusted Cox proportional hazards and propensity score-matched models. RESULTS: Median follow-up was 2.8 years. In proportional hazards analysis in the placebo group, MACE incidence increased across increasing baseline apoB strata (3.2 [95% CI, 2.9-3.6], 4.0 [95% CI, 3.6-4.5], and 5.5 [95% CI, 5.0-6.1] events per 100 patient-years in strata <75, 75-<90, >= 90 mg/dL, respectively; P-trend<0.0001) and after adjustment for low-density lipoprotein cholesterol (P-trend=0.035). Higher baseline apoB stratum was associated with greater relative (P-trend<0.0001) and absolute reduction in MACE with alirocumab versus placebo. In the alirocumab group, the incidence of MACE after month 4 decreased monotonically across decreasing achieved apoB strata (4.26 [95% CI, 3.78-4.79], 3.09 [95% CI, 2.69-3.54], and 2.41 [95% CI, 2.11-2.76] events per 100 patient-years in strata >= 50, >35-<50, and <= 35 mg/dL, respectively). Compared with propensity score-matched patients from the placebo group, treatment hazard ratios for alirocumab also decreased monotonically across achieved apoB strata. Achieved apoB was predictive of MACE after adjustment for achieved low-density lipoprotein cholesterol or non-high-density lipoprotein cholesterol but not vice versa. CONCLUSIONS: In patients with recent acute coronary syndrome and elevated atherogenic lipoproteins, MACE increased across baseline apoB strata. Alirocumab reduced MACE across all strata of baseline apoB, with larger absolute reductions in patients with higher baseline levels. Lower achieved apoB was associated with lower risk of MACE, even after accounting for achieved low-density lipoprotein cholesterol or non-high-density lipoprotein cholesterol, indicating that apoB provides incremental information. Achievement of apoB levels as low as <= 35 mg/dL may reduce lipoprotein-attributable residual risk after acute coronary syndrome.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
Nyckelord
- acute coronary syndrome
- apolipoproteins B
- cholesterol
- LDL
- heart disease risk factors
- PCSK9 inhibitors
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Hagström, Emil
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Steg, P. Gabriel
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Szarek, Michael
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Bhatt, Deepak L.
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Bittner, Vera A.
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Danchin, Nicolas
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Diaz, Rafael
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Goodman, Shaun G ...
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Harrington, Robe ...
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Jukema, J. Woute ...
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Liberopoulos, Ev ...
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Marx, Nikolaus
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McGinniss, Jenni ...
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Manvelian, Garen
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Pordy, Robert
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Scemama, Michel
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White, Harvey D.
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Zeiher, Andreas ...
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Schwartz, Gregor ...
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