Statin medications have long been the main class of medications that have been recommended to lower cholesterol, as they have been shown to be very powerful to reduce the risk of cardiovascular events. Now, a new class of medications joins the ranks of statins: the PCSK9 inhibitor evolocumab (Repatha) has been shown to reduce cardiovascular events.
The top-line results of the study, called the FOURIER study, have now been released. This was a study of 27,500 patients with cardiovascular disease who were already on optimized statin therapy, randomized to receive either evolocumab or placebo. They found that evolocumab reduced the risk of their primary endpoint, which was the sum of cardiovascular death, non fatal heart attack, non fatal stroke, hospitalization for unstable angina, or coronary revascularization (angioplasty).
I am looking forward to learning more about the results of this trial and the amount by which risk was reduced – these data will be released in March at the American College of Cardiology meeting in Washington DC. It will be interesting to compare these results to the results of the IMPROVE-IT trial, which showed that the combination of statin therapy with the cholesterol lowering medication ezetimibe lowered the risk of cardiovascular death, major coronary events, or non fatal stroke by 2.0 percentage points compared to statin therapy alone.
It is encouraging to see a new class of cholesterol medications being developed that reduce cardiovascular events. There are many patients who do not tolerate statin therapy; perhaps the PCSK9 inhibitors may also reduce cardiovascular risk for them (studies on this are currently underway). PCSK9 inhibitors are extremely expensive, which limits their use in clinical practice. Perhaps with these data, guidelines will be revised and we may hopefully see more coverage options so that the benefits of PCSK9 inhibitors to reduce cardiovascular events can be more widely enjoyed.
Disclaimer: I have been involved in a clinical trial of PCSK9 inhibition. I have received honoraria as a medical education speaker and consultant from the makers of ezetimibe (Merck).