LDL-C Lowering Reduces Heart Attacks and Cardiac Deaths

For people with atherosclerotic cardiovascular disease (ASCVD) the message from a study published today in the journal Circulation and presented at the annual European Society of Cardiology (ESC) meeting is loud and clear. Lower your LDL cholesterol (LDL-C) as much as possible, as soon as possible, and keep it low – doing so not only reduces heart attacks, it prevents cardiac death as well!

The FOURIER-OLE (Further cardiovascular OUtcomes Research with PCSK9 Inhibition in Subjects with Elevated – Risk-Open Label Extension) included 6,635 patients who were all participants of the original FOURIER trial which compared evolocumab (Repatha) to placebo. The original study (or parent study) followed patients up to a maximum of about 3.4 years and found a 15% reduction in cardiac events in favor of those receiving evolocumab. FOURIER-OLE included 3,355 people who received evolocumab in the parent study and 3,280 who had received placebo. In the FOURIER-OLE, everyone was treated with evolocumab for approximately 5 years. During the OLE the two groups had similar LDL cholesterol (LDL-C) levels. In fact, 80% of study participants were able to get their LDL-C to below 55 mg/dL. Some people even lowered their LDL-C into the teens and twenties with no ill effects.

One very important finding was that the group who received evolocumab both in the parent trial and in the OLE experienced significantly fewer vascular events than those who only received evolocumab in the OLE.

Compared to the patients who were on placebo in the parent study, those who were on evolocumab for both the parent and in the OLE enjoyed a 15% lower risk of cardiovascular death, heart attack, stroke, hospitalization for unstable angina or coronary revascularization, a 20% lower risk of cardiovascular death, heart attack or stroke, and a 23% lower risk of cardiovascular death.

This reminds me of the old saying: “When’s the best time to plant a tree? Answer: 20 years ago, and the next best time is now!”
When is the best time to lower your LDL? Answer: 8.4 years ago, and the next best time is now!

Through this OLE we also learn that evolocumab continues to be safe and well tolerated long-term.

The take home message from this important study for people with cardiovascular disease and high LDL-C, and especially for those living with familial hypercholesterolemia (FH) who have had elevated LDL-C since birth is simple: Get your LDL as low as possible, as soon as possible, and keep it there!
“This study further demonstrates the safety and effectiveness of evolocumab for patients with elevated LDL-C and atherosclerotic cardiovascular disease and those most vulnerable to cardiovascular disease, such as the 1.3 million Americans born with Familial Hypercholesterolemia.

Our research at the Family Heart Foundation has shown that the vast majority of high-risk patients in America are never prescribed combination treatment, including a PCSK9 inhibitor, despite their LDL-C not being at the levels recommended by guidelines. In addition, those who are prescribed PCSK9 inhibitors are often denied coverage by their insurance plan, or have a high out of pocket co-pay that prevents them from filling their prescription. The result is that we are losing the fight against heart disease despite having the therapeutic tools to save lives. We are hopeful that this new evidence will result in more appropriate care for patients.

Katherine Wilemon
Family Heart Foundation, Founder & CEO