Evolocumab

点击“蓝字”关注我们血脂代谢与心血管健康息息相关，每一项新研究都可能为临床实践带来革新。本期为您呈现国际期刊血脂领域研究成果集锦，从Omega-3疗法的心血管益处剖析，到PCSK9抑制剂（PCSK9i）在特定患者群体中的疗效验证；从药物基因组学视角解读他汀类药物不良反应，到SGLT2抑制剂（SGLT2i）对患者血脂及肾功能的影响探索，更有中国患者依洛尤单抗应用成果、脂蛋白与心血管疾病关联等前沿内容。这些研究跨越基础机制与临床实践，多维度揭示血脂研究的深度与广度。期待这些成果能助力医学界进一步明晰血脂管理路径，为广大患者带来更精准、有效的健康守护。评估Omega-3疗法及其心血管益处：系统综述和荟萃分析揭示IPE的作用二十碳五烯酸乙酯（IPE）是一种高度纯化的EPA制剂，可以降低TG，改善斑块稳定性，减少血小板聚集，预防心血管事件。IPE经常与他汀类药物一起用于控制TG水平升高。系统综述证据表明，IPE在降低包括TG在内的血脂水平、减少心血管死亡及非致死性卒中、不稳定型心绞痛住院等事件方面有效。然而，值得注意的是，这些结果主要来自接受他汀类药物治疗的患者。结果显示，IPE具有抗炎，抗血栓形成和抗动脉粥样硬化的特性，与心血管保护高度相关。根据纳入的研究，IPE被认为是动脉粥样硬化性心血管疾病的一种有前途的治疗方法，与其他降脂疗法（特别是他汀类药物）一起用于TG水平极高的患者。Nathália Mendes Machado, et al.Assessing Omega-3 Therapy andts Cardiovascular Benefits: WhatAbout lcosapent Ethyl? ASystematic Review and Meta-Analysis.Pharmaceuticals/Volume18/lssue4/10.3390/ph18040601PCSK9i可减少CKD合并ST段抬高型心肌梗死患者的心血管事件冠状动脉慢血流和无复流现象是急性心肌梗死（AMI）患者预后不良的重要预测因素，尤其对合并慢性肾脏病（CKD）者更为显著。早期识别相关危险因素有助于减少缺血事件并改善临床结局。该研究显示，与非CKD患者相比，合并CKD的STEMI患者Lp(a)水平显著更高（中位数36.75 vs. 15.90 mg/dl，P=0.0001）。Lp(a)水平升高是合并CKD的STEMI患者PCI后发生冠脉慢血流或无复流的独立危险因素。PCSK9i可改善此类患者的冠状动脉血流并减少心血管事件。Hao Xu, Ziqing Wang, Dan Chen,et al.PCSK-9 Inhibitors Can Significantlylmprove the Coronary Slow Flow Causedby Elevated Lipoprotein(a)in ST-ElevationMyocardialInfarction Patients With Chronic Kidney Disease.First published: 25 April 2025阿托伐他汀和瑞舒伐他汀不良反应的药物基因组学见解：阿联酋的一项前瞻性观察性研究他汀类药物在心血管疾病（CVD）中的地位不容置疑，但不良反应通常会导致患者依从性差而治疗中断，强调治疗需个性化。阿联酋的这项前瞻性观察性研究旨在评估药物基因组学（PGx）变异和人口统计学因素对阿拉伯联合酋长国（UAE）多种族队列中他汀类药物相关不良反应的影响。研究使用实时PCR对患者进行SLCO1B1和ABCG2可操作变体的基因分型。结果显示，携带ABCG2 rs2231142变异体的瑞舒伐他汀使用者肝酶升高风险增加三倍，在东亚患者中尤为显著（P＜0.005）。携带SLCO1B1 rs4149056变异体的阿托伐他汀使用者发生严重肌肉不良事件（SAMS）的风险增加两倍，在女性和阿拉伯人群中发生率更高（P＜0.05）。瑞舒伐他汀与依折麦布联用进一步加剧了SAMS和肝酶升高的风险。研究指出，在优化他汀类药物个体化治疗方案以最大限度降低不良反应风险的过程中，基因检测结果与人口统计学特征（包括种族和性别等关键因素）的整合分析具有至关重要的指导价值。Mais N Alqasrawi, Zeina N Al-Mahayri, Areej S AlBawa'neh,et al.Pharmacogenomic insights intoatorvastatin and rosuvastatinadverse effects: a prospectiveobservational study in the UAE'smultiethnic population.Human Genomics,19,Article number: 44(2025).SGLT2抑制剂对CKD患者血脂谱及肾功能的影响大量研究表明，钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）通过多效性作用可延缓CKD进展。该研究探讨了SGLT2i治疗对CKD患者血脂水平及肾功能的影响。研究对75例接受SGLT2i治疗的CKD患者进行回顾性数据分析。比较两个时间点（基线期与治疗24个月后）的生化指标、肾功能参数及血压变化。所有患者总胆固醇均显著降低，甘油三酯与低密度脂蛋白胆固醇水平亦呈下降趋势。高密度脂蛋白胆固醇水平有所升高但未达统计学显著性。肌酐清除率显著降低，血清尿素显著升高，而蛋白尿水平无显著变化。所有患者舒张压均显著下降。研究表明，在24个月随访期间，无论是否合并糖尿病，SGLT2i均可降低CKD患者总胆固醇水平。Selena Gaji , Stefan Jankovi , Milorad Stojadinovi ,et al.The Effects of SGLT2 inhibitors onLipid Profile and Kidney Functionin Patients with Chronic KidneyDisease Regardless of Diabetesand Hypertension Status.Metabolites 2025,15(4),271.hs-CRP/HDL-C可以预测心肾代谢综合征1~4期患者全因死亡的风险研究旨在探讨高敏C反应蛋白与高密度脂蛋白胆固醇比值（hs-CRP/HDL-C）与心肾代谢综合征（CKM）1~4期患者长期死亡率之间的潜在关联。结果显示，在CKM综合征1~4期患者中，10年全因死亡率为14.1%。校正潜在混杂因素后，Cox回归模型显示hs-CRP/HDL-C比值与患者长期死亡风险呈显著线性正相关，该比值每升高一个四分位数，死亡风险增加15%。该突破性发现不仅为制定基于风险分层的早期精准干预策略提供了核心生物标志物证据，更通过构建预后预测模型实现了高危患者的早期预警，为优化此类复杂代谢综合征的临床决策路径提供了创新性理论框架。Fengjiao Han, Haiyang Guo, Hao Zhang,et al.Cardiovascular Endocrinology,Volume 16-2025.中国ASCVD患者使用依洛尤单抗降低LDL-C水平既往试验表明，在他汀类药物治疗基础上加用依洛尤单抗可使低密度脂蛋白胆固醇（LDL-C）水平降低约60%。近期公布的这项队列研究评估了中国临床实践中依洛尤单抗的降LDL-C效果。数据来源于天津区域医疗数据库（TRHD），该数据库包含天津地区服务超1500万居民的公立医院电子健康记录（EHR）。研究队列纳入2019-2023年间在他汀治疗基础上加用依洛尤单抗的动脉粥样硬化性心血管疾病（ASCVD）成人患者。结果：基线时，依洛尤单抗组（n=395）LDL-C中位数（四分位距[IQR]）为3.44（2.73~4.15）mmol/L，稳定他汀组（n=4160）为2.20（1.72~2.92）mmol/L。随访显示，依洛尤单抗组LDL-C平均降幅（95%CI）达63.0%（60.5%~65.5%），显著高于稳定他汀组的2.5%（0.3%~4.7%）。中国真实临床实践中，他汀治疗基础上加用依洛尤单抗的降LDL-C幅度与临床试验结果一致。Liming Zhao, Jiamei Liu, Yin Liu, et al.LDL-C Reduction withEvolocumabAmongPatientswith ASCvD in China: Real-World Evidence from TianjinMetropolitan Area. Original Research,25 April 2025.脂蛋白(a)与ASCVD的风险：高敏C反应蛋白的影响Lp(a)升高与ASCVD发病风险增加相关。本研究旨在评估Lp(a)作为2019年ACC/AHA指南推荐的ASCVD风险增强因素的实用性，并探讨C反应蛋白（CRP）是否会改变Lp(a)升高与ASCVD风险的关联。结果显示，与最低Lp(a)类别（＜10 mg/dl）相比，最高Lp(a)类别（≥50 mg/dl）的ASCVD（HR=1.31；95%CI: 1.15-1.50；P＜0.001）和CHD（HR=1.49；95%CI：1.27-1.75；P＜0.001）发生率显著增加。Lp(a)升高与ASCVD发病的关联在男性和非黑人个体中更强，且独立于糖尿病状态。对于中等风险人群（10年ASCVD风险≥7.5%），Lp(a)≥50 mg/dl可预测其10年ASCVD风险。另一方面，Lp(a)与hs-CRP之间存在显著交互作用：Lp(a)和hs-CRP同时升高的个体ASCVD风险最高。Ron C Hoogeveen, et al.Lipoprotein(a) and Risk of incidentAtherosclerotic CardiovascularDisease: lmpact of High-SensitivityC-Reactive Protein and RiskVariability Among Human ClinicalSubgroups.Nutrients /Volume17 /lssue 8.10.3390/ny17081324残余胆固醇的遗传学特征ASCVD患者经他汀类药物干预后仍存在的残余心血管风险，正促使残余胆固醇成为新兴治疗靶标的研究热点。随着基因治疗技术的突破性进展，以反义寡核苷酸（ASO）、小干扰RNA（siRNA）及单克隆抗体为代表的靶向干预工具，为精准调控脂质代谢相关基因及蛋白表达提供了技术支撑。基于此，通过解析残余胆固醇的遗传调控网络并建立其与ASCVD风险的量化关联模型，已成为筛选新型药物靶标及验证传统干预靶点的关键策略。人类遗传流行病学研究已系统鉴定出多个调控血浆残余胆固醇浓度的脂蛋白代谢相关基因变异位点。其中，脂蛋白脂酶（LPL）作为残余脂蛋白清除通路的核心酶类，其活性水平直接决定血浆残余胆固醇的代谢速率。而载脂蛋白C3（APOC3）、血管生成素样蛋白3/4（ANGPTL3/4）等基因通过编码LPL抑制因子或调节蛋白，构成影响残余胆固醇稳态的遗传调控网络。现有证据表明，血浆残余胆固醇水平升高可能是ASCVD病理进程的独立危险因素。基于遗传学研究，已有多组与LPL功能密切相关的基因变异被确立为潜在治疗靶点，其中部分靶点已进入临床转化阶段，另有多个候选基因正在开展降脂疗效及心血管获益的临床验证研究。Anders B Wulff, B rge G Nordestgaard, et al.Genetics of remnant cholesterol.Current Opinion in Lipidology: 10.1097/MOL.0000000000000991, April23,2025.声明：本文仅供医疗卫生专业人士了解最新医药资讯参考使用，不代表本平台观点。该等信息不能以任何方式取代专业的医疗指导，也不应被视为诊疗建议，如果该信息被用于资讯以外的目的，本站及作者不承担相关责任。最新《心肾代谢时讯》读者专属微信交流群建好了，快快加入吧！扫描左边《心肾代谢时讯》小助手二维码（微信号：CKM-Times），回复“心肾代谢读者”，ta会尽快拉您入群滴！（来源：《心肾代谢时讯》编辑部）

iStock, hapabapa Like fellow Big Pharmas Eli Lilly and Johnson & Johnson, Amgen is urging the Trump administration to consider tax policy instead of tariffs to promote domestic pharma manufacturing. Instead of slapping tariffs on pharmaceutical products, Amgen argues that domestic manufacturing could be better off with “pro-growth tax policy,” company executives said during the company’s first quarter earnings call. “To build on the manufacturing base in the U.S., we agree with our peers that the most effective answer is not tariffs but tax policy,” CFO Peter Griffith said on Thursday’s call. At least in Amgen’s case, President Donald Trump’s Tax Cuts and Jobs Act, filed in 2017 under his first term, led to significant increases in manufacturing investment. Regarding Trump’s pharma tariffs, CEO Bob Bradley said it is “premature to speculate” on the impacts these may have on Amgen’s business. Regardless of the “uncertainty,” however, Bradley emphasized that “we’ve proven our ability to adapt and we’ve demonstrated the operating agility necessary to navigate change.” Amgen isn’t alone in advocating for tax policy over tariffs while also touting investments in the U.S. Like Lilly and J&J , both companies that have spoken out against tariffs in favor of changing tax policy, Amgen is pouring more money into its U.S. operations. Last week, Amgen announced a $900 million investment to expand its production plant in Ohio and create 350 new jobs in the region. In the first quarter, Amgen posted a 9% year-on-year sales bump , bringing in $8.1 billion in the first three months of 2025, falling largely in line with analyst expectations. Its main business drivers were the postmenopausal osteoporosis injection Prolia, which raked in nearly $1.1 billion, and the cholesterol-lowering treatment Repatha, which hit $656 million in Q1 sales. Aside from tariffs, Amgen’s next-generation weight-loss drug MariTide was the dominant focus on the earnings call. The pharma will present full Phase II data for the drug candidate in June at the upcoming Scientific Sessions of the American Diabetes Association. In November last year, a peek at these findings underwhelmed investors , with MariTide’s weight-loss falling on the lower end of what analysts had expected. Despite these mixed mid-stage findings, Amgen on Thursday remained confident in MariTide. Justin Claeys, vice president of Investor Relations, pointed to the drug’s “strong efficacy,” which showed “no plateau [at] 52 weeks.” MariTide was also well-tolerated at its target dose. Amgen has also initiated two Phase III trials for MariTide for chronic weight management, with plans to start additional studies “later this year,” looking at specific subpopulations of patients with obesity, Claeys added. Looking ahead to the rest of the year, Amgen reiterated its 2025 forecast, anticipating full-year revenues of $34.3 billion to $35.7 billion. This forecast takes into account the potential effects of the current tariffs but has not yet accounted for additional duties that could be implemented, including pharma-specific tariffs, Griffith said during the investor call.