Physicians' Academy for Cardiovascular Education

Also at very low achieved LDL-c is ‘the lower better’ for cardiovascular risk

ESC 2017 - Barcelona

News - Aug. 27, 2017

New analysis examines how low cholesterol can safely go (FOURIER)

Presented at the ESC congress 2017 by:Robert Patrick GIUGLIANO (Boston, MA, USA)


Intitial results of the FOURIER study showed that the PCSK9 antibody evolocumab lowered LDL-c levels significantly to a median of 0.8 mmol/L, as well as the risk of cardiovascular events during a median follow-up of 2.2 years.

During the ESC data of new analyses of the FOURIER trial were presented, in which efficacy and safety were evaluated in relation tot he achieved LDL-c level at month 1 (25.982 patients). Patients were categorized into 5 groups: 1) <0.5 mM (20 mg/dL), 2) 0.5-1.3 mM (20-49 mg/dL), 3) 1.3-1.8 mM (50-69 mg/dL), 4) 1.8-2.6 mM (70-99 mg/dL) and 5) ≥2.6 mM (≥100 mg/dL), the latter of which functioned as a reference group. Moreover, in the EBBINGHAUS population cognition was evaluated.

Main results


LDL-c can be lowered to unprecendented low levels, when using statins and PCSK9 inhibitors. A strong linear relationship was seen between achieved LDL-c levels and number of CV events, even below 0.26 mM LDL-c, without safety concerns up to 2.2 years. These data suggest that LDL-c must be lowered even further than is currently recommended for patients with atherosclerotic CVD.

Giugliano therefore emphasized during the press conference that the “lower the better” really seems true. He also noted that the exploratory data of the extremely low LDL-c group show a fantastic result that may support guideline recommendations to go as low as possible with LDL-c.

- Our reporting is based on the information provided at the ESC congress -

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