Abstract：
To summarize selected late-breaking science on cardiovascular (CV) disease prevention presented at the 2023 American College of Cardiology (ACC) conference.
The CLEAR outcomes randomized control trial (RCT) compared bempedoic acid to placebo in patients at high-risk of cardiovascular disease (CVD) or prevalent CVD and statin intolerance for CV outcomes. The YELLOW III was a single-arm study that evaluated the effect of Evolocumab on coronary plaque characteristics in patients with stable coronary artery disease (CAD). A cohort evaluated the association between a self-reported low-carbohydrate high-fat (ketogenic) diet and serum lipid levels as compared to a standard diet. The LOADSTAR trial compared CV outcomes with targeted low-density lipoprotein cholesterol (LDL-C) approach vs. high-intensity statin in patients with CAD. The PCDS statin cluster randomized trial compared the effectiveness of an electronic reminder to the clinician on a high-intensity statin use among patients with a history of ASCVD as compared to no reminder. A prospective cohort study compared the extent of coronary atherosclerosis among lifelong endurance athletes and healthy non-athletes. A causal artificial intelligence study combined polygenic risk scores with data from large CV prevention RCTs to guide systolic blood pressure and LDL-C reduction targets to reach average CV risk. The ACCESS trial evaluated the impact of eliminating copayment for low-income older adults in Canada with chronic CV diseases on composite CV outcomes. A pooled analysis of 3 large RCTs evaluated the association between residual inflammatory risk and CV outcomes, as compared to residual elevated cholesterol risk in patients receiving statin therapy. A Phase 2B RCT compared the efficacy of an oral PCSK9i, MK-0616, in reducing LDL-C as compared to a placebo. The late-breaking clinical science presented at the 2023 conference of the ACC paves the way for an evidence-based alternative to statin therapy and provides data on several common clinical scenarios encountered in daily practice.
The CLEAR outcomes randomized control trial (RCT) compared bempedoic acid to placebo in patients at high-risk of cardiovascular disease (CVD) or prevalent CVD and statin intolerance for CV outcomes. The YELLOW III was a single-arm study that evaluated the effect of Evolocumab on coronary plaque characteristics in patients with stable coronary artery disease (CAD). A cohort evaluated the association between a self-reported low-carbohydrate high-fat (ketogenic) diet and serum lipid levels as compared to a standard diet. The LOADSTAR trial compared CV outcomes with targeted low-density lipoprotein cholesterol (LDL-C) approach vs. high-intensity statin in patients with CAD. The PCDS statin cluster randomized trial compared the effectiveness of an electronic reminder to the clinician on a high-intensity statin use among patients with a history of ASCVD as compared to no reminder. A prospective cohort study compared the extent of coronary atherosclerosis among lifelong endurance athletes and healthy non-athletes. A causal artificial intelligence study combined polygenic risk scores with data from large CV prevention RCTs to guide systolic blood pressure and LDL-C reduction targets to reach average CV risk. The ACCESS trial evaluated the impact of eliminating copayment for low-income older adults in Canada with chronic CV diseases on composite CV outcomes. A pooled analysis of 3 large RCTs evaluated the association between residual inflammatory risk and CV outcomes, as compared to residual elevated cholesterol risk in patients receiving statin therapy. A Phase 2B RCT compared the efficacy of an oral PCSK9i, MK-0616, in reducing LDL-C as compared to a placebo. The late-breaking clinical science presented at the 2023 conference of the ACC paves the way for an evidence-based alternative to statin therapy and provides data on several common clinical scenarios encountered in daily practice.
摘要：
目的：总结在2023年美国心脏病学会（ACC）会议上发表的有关心血管（CV）疾病预防的最新科学。
结果：CLEAR结局随机对照试验（RCT）比较了bempedoicacid与安慰剂在心血管疾病（CVD）或心血管疾病流行和他汀类药物不耐受的高风险患者中的CV结局。YELLOWIII是一项单臂研究，旨在评估Evolocumab对稳定型冠状动脉疾病（CAD）患者冠状动脉斑块特征的影响。与标准饮食相比，一个队列评估了自我报告的低碳水化合物高脂肪（生酮）饮食与血脂水平之间的关联。LOADSTAR试验比较了采用靶向低密度脂蛋白胆固醇（LDL-C）方法的CV结局与高强度他汀类药物在CAD患者中的应用。PCDS他汀类药物整群随机试验比较了在有ASCVD病史的患者中，对临床医生进行高强度他汀类药物使用电子提醒的有效性，与无提醒相比。一项前瞻性队列研究比较了终身耐力运动员和健康非运动员的冠状动脉粥样硬化程度。因果人工智能研究将多基因风险评分与来自大型CV预防RCT的数据相结合，以指导收缩压和LDL-C降低目标达到平均CV风险。ACCESS试验评估了在加拿大消除患有慢性CV疾病的低收入老年人的共付额对复合CV结局的影响。对3个大型随机对照试验的汇总分析评估了残余炎症风险与心血管结局之间的关系。与接受他汀类药物治疗的患者的残余胆固醇升高风险相比。2B期RCT比较了口服PCSK9i的疗效，与安慰剂相比，MK-0616降低了LDL-C。ACC2023年会议上提出的最新临床科学为他汀类药物治疗的循证替代方案铺平了道路，并提供了日常实践中遇到的几种常见临床方案的数据。
结果：CLEAR结局随机对照试验（RCT）比较了bempedoicacid与安慰剂在心血管疾病（CVD）或心血管疾病流行和他汀类药物不耐受的高风险患者中的CV结局。YELLOWIII是一项单臂研究，旨在评估Evolocumab对稳定型冠状动脉疾病（CAD）患者冠状动脉斑块特征的影响。与标准饮食相比，一个队列评估了自我报告的低碳水化合物高脂肪（生酮）饮食与血脂水平之间的关联。LOADSTAR试验比较了采用靶向低密度脂蛋白胆固醇（LDL-C）方法的CV结局与高强度他汀类药物在CAD患者中的应用。PCDS他汀类药物整群随机试验比较了在有ASCVD病史的患者中，对临床医生进行高强度他汀类药物使用电子提醒的有效性，与无提醒相比。一项前瞻性队列研究比较了终身耐力运动员和健康非运动员的冠状动脉粥样硬化程度。因果人工智能研究将多基因风险评分与来自大型CV预防RCT的数据相结合，以指导收缩压和LDL-C降低目标达到平均CV风险。ACCESS试验评估了在加拿大消除患有慢性CV疾病的低收入老年人的共付额对复合CV结局的影响。对3个大型随机对照试验的汇总分析评估了残余炎症风险与心血管结局之间的关系。与接受他汀类药物治疗的患者的残余胆固醇升高风险相比。2B期RCT比较了口服PCSK9i的疗效，与安慰剂相比，MK-0616降低了LDL-C。ACC2023年会议上提出的最新临床科学为他汀类药物治疗的循证替代方案铺平了道路，并提供了日常实践中遇到的几种常见临床方案的数据。
