PCSK-9 and Cardiovascular Outcomes

iStock-157614058Scientific jargon can be tedious, and so it is with this new agent Rick and I discuss on PodMed this week, a PCSK9 inhibitor called evolocumab, and long term cardiovascular outcomes, as published in NEJM. As I opine to Rick, I can hardly wait for the proprietary name as the consonants strung together just don't slide easily off the tongue, and based on the results of this study these agents will no doubt be in widespread clinical use soon. What did the study show?

Almost 28,000 people with both atherosclerotic cardiovascular disease and LDL cholesterol of 70 mg/dl or higher and who were already taking statins were randomized to either the monoclonal antibody evolocumab or to placebo. Study participants received the antibody or placebo by subcutaneous injection once every two weeks.  After a median 2.2 years of follow up the primary composite endpoint was cardiovascular death, heart attack, stroke, hospitalization for unstable angina or revascularization. When compared with placebo the PCSK9 inhibitor achieved an almost 60% reduction in LDL cholesterol. Even more importantly, the drug reduced the likelihood of an adverse cardiovascular event significantly. Rick opines that the conclusion seems clear: reducing LDL cholesterol even more than can be achieved with statins alone does reduce the risk of cardiovascular outcomes in those at risk, and believes these agents will soon be used widely, noting that there were no adverse events seen in either arm of the study.

Other topics this week include two more from NEJM: Bystander Efforts in Out-of-Hospital Cardiac Arrest and Tofacitinib for Ulcerative Colitis, and in Annals of Internal Medicine, Handgun Acquisitions in California After Two Mass Shootings. Until next week, y'all live well.

 

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