Physicians' Academy for Cardiovascular Education

Acute arterial events reduced by PCSK9 inhibitor across all vascular territories

Effect of evolocumab on acute arterial events across all vascular territories: results from the FOURIER trial

Literature - Oyama K, Giugliano RP, Tang M et al., - Eur Heart J 2021, doi: 10.1093/eurheartj/ehab604

Introduction and methods

Acute arterial vascular events in the coronary, cerebrovascular, and peripheral beds share related underlying pathophysiological mechanism, but the total burden of acute events is not often reported in patients with high CV risk [1]. In addition, the effect of lipid-lowering therapy on total burden of acute events has not been well studied [2,3].

In the FOURIER trial, the PCSK9 inhibitor evolocumab reduced major adverse CV events compared to placebo in patients with stable atherosclerotic CVD (ASCVD) on statin therapy [4-6]. And there was benefit of evolocumab in reducing coronary, cerebrovascular, and peripheral vascular events.

FOURIER was a randomized, double-blind, placebo-controlled trial that included 27564 patients with prior MI, stroke or peripheral artery disease (PAD). LDL-c had to be ≥70 mg/dL or non-HDL-c ≥100 mg/dL while patients were on statin therapy with or without ezetimibe. Patients were randomized to evolocumab or matching placebo, and followed for a median of 2..2 years (IQR: 1.8-2.5 years).

In this post hoc analysis of the FOURIER trial, the burden of acute arterial events across vascular territories and the effect of lipid lowering by evolocumab on these events was investigated.

Outcomes were acute arterial events defined as a composite of coronary (CHD death, MI or urgent coronary revascularization), cerebrovascular (ischemic stroke, transient ischemic attack or urgent cerebral revascularization), or peripheral vascular (acute limb ischemia, major amputation, or urgent peripheral revascularization) events.

Main results


This post hoc analysis of FOURIER showed that treatment with the PCSK9 inhibitor evolocumab in high CV risk patients reduced the risk of acute arterial events in all vascular beds. Acute coronary events were the common events in these high-risk patients, followed by acute cerebrovascular and peripheral vascular events. There was a robust effect of evolocumab over time on reducing both first and recurrent events.


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