Evolocumab and Cardiovascular Events in Patients With Diabetes Without Known Significant Atherosclerosis
To the Editor To me, the principal unanswered question raised by the Effect of Evolocumab in Patients at High Cardiovascular Risk Without Prior Myocardial Infarction or Stroke (VESALIUS-CV) trial is whether that trial supports use of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibition for primary prevention in high-risk patients or whether its findings are partly driven by incomplete…
The Evolocumab trial has raised an important question about the role of PCSK9 inhibition for primary prevention in high-risk patients, particularly those with diabetes and without known significant atherosclerosis. While 84% to 85% of participants were already on statins at baseline, only 63% to 65% were receiving high-intensity statin therapy, and ezetimibe use was around 14%.
Additionally, only 67% to 68% of participants received a regimen expected to reduce low-density lipoprotein cholesterol levels by more than 50%. In this context, the reported reduction in cardiovascular events might be partially due to the improvement in background lipid-lowering therapy rather than the independent effect of adding a PCSK9 inhibitor on top of optimized standard treatment.
A stratified analysis focusing on patients already on high-intensity statin therapy, with or without ezetimibe, would provide valuable insights. If a similar effect is observed in this subgroup, it would further support the potential additive benefit of PCSK9 inhibition. Conversely, if the effect is weakened, the findings would suggest that optimizing conventional therapy should be the priority before intensifying medication.
Written by urgent.news from JAMA's reporting — not their text. Machine-written — may contain errors; check the original before relying on it.
