Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

LDL-C Lowering with Evolocumab in Patients with PAD

Circulation; ePub 2017 Nov 13; Bonaca, et al

In patients with peripheral artery disease (PAD), proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibition with evolocumab significantly reduced the risk of cardiovascular (CV) events, with large absolute risk reductions. This according to results from the FOURIER trial, which also showed that lowering of low-density lipoprotein cholesterol (LDL-C) with evolocumab reduced the risk of major adverse limb events. FOURIER is a randomized trial of evolocumab vs placebo in 27,564 patients with atherosclerotic disease on statin therapy for a median of 2.2 years. 3,642 patients (13.2%) had PAD (1,505 with no prior MI or stroke). The primary end point was a composite of CV death, myocardial infarction (MI), stroke, hospital admission for unstable angina, or coronary revascularization. The key secondary end point was a composite of CV death, MI, or stroke. Researchers found:

  • Evolocumab significantly reduced the primary end point consistently in patients with PAD (HR, 0.79) and without PAD (HR, 0.86).
  • For the key secondary end point, HRs were 0.73 for those with PAD and 0.81 for those without PAD.
  • Evolocumab also reduced the risk of major adverse limb events in all patients with consistent effects in those with and without known PAD.

Citation:

Bonaca MP, Nault P, Giugliano RP, et al. Low-density lipoprotein cholesterol lowering with evolocumab and outcomes in patients with peripheral artery disease. [Published online ahead of print November 13, 2017]. Circulation. doi:10.1161/CIRCULATIONAHA.117.032235.

This Week's Must Reads

Lipid Testing After Acute Myocardial Infarction, J Am Heart Assoc; ePub 2018 Jan 25; Wang, et al

Clinical Pharmadynamics of Evolocumab, Clin Pharmacokinet; ePub 2018 Jan 20; Kasichayanula, et al

Lipoproteins & CV Outcomes in Dialysis Patients, J Clin Lipidol; ePub 2017 Dec 26; Kaysen, et al

Is Dual Lipid-Lowering Therapy Better?, Atherosclerosis; 2018 Feb; Gragnano, et al

sLOX-1 in Ischemic Stroke & Transient Ischemic Attack, J Am Heart Assoc; ePub 2018 Jan 12; Skarpengland, et al

Must Reads in Hypercholesterolemia

Lipid Testing After Acute Myocardial Infarction, J Am Heart Assoc; ePub 2018 Jan 25; Wang, et al

Clinical Pharmadynamics of Evolocumab, Clin Pharmacokinet; ePub 2018 Jan 20; Kasichayanula, et al

Lipoproteins & CV Outcomes in Dialysis Patients, J Clin Lipidol; ePub 2017 Dec 26; Kaysen, et al

Is Dual Lipid-Lowering Therapy Better?, Atherosclerosis; 2018 Feb; Gragnano, et al

sLOX-1 in Ischemic Stroke & Transient Ischemic Attack, J Am Heart Assoc; ePub 2018 Jan 12; Skarpengland, et al