Evolocumab associated with significant drop in heart attack risk

Taking evolocumab to lower LDL cholesterol can lead to significant reductions in a patient’s risk of myocardial infarction (MI), according to new findings published by JAMA Cardiology.

The study’s authors turned to the Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk (FOURIER) trial, using data from than 27,000 patients to investigate evolocumab’s impact. While 75% of study participants were male, the mean age was 62.5 years old.

Overall, 1,107 patients experienced 1,288 MIs over the course of the FOURIER trial. Sixty-eight percent of those MIs were atherothrombotic, or type 1, and 15% were myocardial oxygen supply-demand mismatch, or type 2. Another 15% of the MIs were PCI-related, or type 4. Less than 2% of MIs were sudden death (type 3) or coronary artery bypass grafting-related (type 5).

Based on the team’s analysis, evolocumab was associated with reducing first MIs by 27%, type 1 MIs by 32% and type 4 MIs by 35%. No effect was observed for type 2 MIs. There was also a 36% reduction in the risk of STEMI.

In addition, the authors noted, there is reason to believe taking evolocumab  for LDL cholesterol leads to fewer deaths related to cardiovascular (CV) health.

“Although FOURIER did not demonstrate a reduction of CV death during the trial, the reduction of larger and severe MIs raises the possibility that over a longer duration of follow-up, such a benefit may have been possible,” wrote lead author Stephen D. Wiviott, MD, Brigham and Women’s Hospital in Boston, and colleagues. “This hypothesis is supported by the clear and graded association of increasing MI size with increased risk, suggesting that a robust reduction of larger MIs would lead over time to a mortality reduction. In another trial of a PCSK9 that had longer follow-up, a nominal reduction in mortality was achieved.”

In 2019, researchers determined evolocumab was safe and “consistently excellent” for lowering LDL cholesterol.