Patients with peripheral vascular disease or prior acute myocardial infarction (especially within the first two years after the event) could find a particular benefit the PCSK9 receptor inhibitor evolocumab.
Given its high cost, the drug is not yet cost/effective and when prescribed, most patients were no table to complete the treatment.
The FOURIER study showed adding evolocumab to intensive care therapy with statins in patients with atherosclerosis reduces risk of death, MI, stroke, hospitalization for unstable angina or coronary revascularization when compared against placebo. Relative reduction is 15%, with an absolute difference of 1.5% mainly driven by non-fatal events.
In the 3642 patients presenting symptomatic peripheral vascular disease, evolucumab showed more benefits with absolute risk reduction of 3.5% and number needed to treat from 25 to 2.5 years vs NNT 72 in the same period for patients with no history of peripheral vascular disease.
Original title: Low-density lipoprotein cholesterol lowering with evolocumab and outcomes in patients with peripheral artery disease insights from the FOURIER trial (further cardiovascular outcomes research with PCSK9 inhibition in subjects with elevated risk).
Reference: Bonaca MP et al. Circulation. 2017; Epub ahead of print.
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