Evolocumab Reduces First Major Cardiovascular Events in High-Risk Patients Without Known Significant Atherosclerosis

In high-risk patients with diabetes but no known significant atherosclerosis, treatment with evolocumab significantly reduced the risk of a first major cardiovascular event compared with placebo when added to statin therapy. This prespecified subgroup analysis of the VESALIUS-CV randomized, double-blind, placebo-controlled trial included 3,655 participants from 774 sites across 33 countries, all without prior myocardial infarction or stroke and with elevated LDL-C levels. Over a median follow-up of 4.8 years, evolocumab substantially lowered LDL-C levels and reduced both the 3-point composite of coronary heart disease death, myocardial infarction, or ischemic stroke and the 4-point composite that also included ischemia-driven revascularization, with absolute risk reductions of about 2–3% over five years. In addition, all-cause mortality was lower in the evolocumab group than in the placebo group. These findings suggest that intensive LDL-C lowering with PCSK9 inhibition may help prevent first cardiovascular events in selected high-risk individuals even before clinically significant atherosclerosis is evident. Source: https://jamanetwork.com/