Interv Akut Kardiol. 2018;17(3):181-184

The FOURIER trial: evalocumab in secondary prevention

Jindřich Špinar¹, Lenka Špinarová², Jiří Vítovec²

¹ Interní kardiologická klinika, LF MU a FN Brno

² I. interní-kardioangiologická klinika, FN u sv. Anny, Brno

Elevated LDL cholesterol (LDL-C) concentration is an independent risk factor for cardiovascular morbidity and mortality aimedat by numerous therapeutic interventions. However, despite maximum possible treatment with statins, a wide range of patientsfail to reach satisfactory control. It is these patients who can now be offered modern treatment with proprotein convertasesubtilisin-kexin type 9 (PCSK9) inhibitors. The FOURIER trial involved 27,564 patients with established cardiovascular diseasetreated with a maximum tolerated statin dose who were randomized to receive evalocumab or placebo. The reduction in LDLcholesterol levels with evalocumab was 59 %, from a median of 90 mg/dL to 30 mg/dL, i.e. approximately 0.8 mmol/L. The primaryend point (myocardial infarction, stroke, hospitalization for angina pectoris, revascularization and/or death) was reduced from14.6 % to 12.6 % (p < 0.0001), and the key secondary end point (death, myocardial infarction, and stroke) from 9.9 % to 7.9 % (p <0.0001). There was no effect on all-cause mortality (2.5 % vs. 2.4 %); there was a significant reduction in myocardial infarction rate(4.4 % vs 6.3 %) and stroke rate (2.2 % vs. 2.6 %). It made no difference whether patients received one dose in 2 weeks or one in 4weeks. No significant differences between adverse effects were reported. The Ebbinghaus substudy showed no negative effecton neurocognitive function.

Keywords: cholesterol, evalocumab, mortality, myocardial infarction

Published: October 1, 2018  Show citation