Patients with history of MI see fewer CV events with evolocumab
Patients with a prior MI experience substantial risk reductions with evolocumab, particularly those who had an MI within the prior 2 years, according to a subgroup analysis of the FOURIER trial. [Sabatine MS, et al, AHA 2017, session LBS.02]
The researchers analyzed data from 22,351 patients from the FOURIER trial who had a history of MI and divided them based on time from the most recent MI, the number of prior MIs, and the presence of multivessel coronary artery disease (CAD). In this group, 8,402 patients had their most recent MI within 2 years.
The risk of CV death, MI or stroke was significantly increased in patients with an MI within 2 years (adjusted hazard ratio [HR], 1.36; p<0.001 vs those with an MI ≥2 years ago), ≥2 prior MIs (adjusted HR, 1.90; p<0.001 vs those with 1 prior MI), and residual multivessel CAD (adjusted HR, 1.34; p<0.001 vs those without residual multivessel CAD).
Intensive LDL-cholesterol lowering with evolocumab reduced these patients’ relative risk of major CV events significantly. Relative risk reductions vs placebo were 24 percent for patients with an MI within 2 years (p<0.001; 13 percent for those with an MI ≥2 years ago [p=0.04]), 21 percent for those with ≥2 prior MIs (p=0.006; 16 percent for those with 1 prior MI [p=0.008]), and 30 percent for those with multivessel CAD (p<0.001; 11 percent for those with no multivessel CAD [p=0.055]).
According to lead investigator Professor Marc Sabatine of Brigham and Women’s Hospital in Boston, Massachusetts, US, the risk reductions, coupled with the patients’ higher baseline risk, led to absolute risk reductions of 2.6–3.4 percent over 3 years, and was particularly apparent in the groups with recent MI and multivessel CAD.
“These readily ascertainable clinical features offer one approach to tailoring therapy for our patients,” Sabatine said.