在精准医学时代,针对高危患者特定可改变特征的治疗有可能进一步降低动脉粥样硬化性心血管事件的残余风险.纠正致动脉粥样硬化的血脂异常,然而,仍然是一个主要的未满足的临床需求。血浆甘油三酯升高,有或没有低水平的高密度脂蛋白胆固醇(HDL-C),提供这种常见血脂异常的关键可改变成分,特别是在胰岛素抵抗的情况下,如2型糖尿病。选择性过氧化物酶体增殖物激活受体α调节剂(SPPARMα)的开发提供了解决这一治疗差距的方法。这个联合共识小组评估了第一种SPPARMα激动剂的证据,并得出结论,这种药物代表了一种新的治疗类别,与贝特类药物不同,基于药理活性,and,重要的是,一个安全的肝脏和肾脏的轮廓。正在进行的PROMINENT心血管结局试验是在10,000名2型糖尿病患者中进行测试,甘油三酯升高,和低水平的HDL-C是否使用这种SPPARMα激动剂安全地降低了残余心血管风险。
In the era of precision medicine, treatments that target specific modifiable characteristics of high-risk patients have the potential to lower further the residual risk of atherosclerotic cardiovascular events. Correction of atherogenic dyslipidemia, however, remains a major unmet clinical need. Elevated plasma triglycerides, with or without low levels of high-density lipoprotein cholesterol (HDL-C), offer a key modifiable component of this common dyslipidemia, especially in insulin resistant conditions such as type 2 diabetes mellitus. The development of selective peroxisome proliferator-activated receptor alpha modulators (SPPARMα) offers an approach to address this treatment gap. This Joint
Consensus Panel appraised evidence for the first SPPARMα agonist and concluded that this agent represents a novel therapeutic class, distinct from fibrates, based on pharmacological activity, and, importantly, a safe hepatic and renal profile. The ongoing PROMINENT cardiovascular outcomes trial is testing in 10,000 patients with type 2 diabetes mellitus, elevated triglycerides, and low levels of HDL-C whether treatment with this SPPARMα agonist safely reduces residual cardiovascular risk.