Clinical efficacy and safety of achieving very low LDL-cholesterol concentrations with evolocumab

In a secondary analysis of the FOURIER clinical trial, researchers considered the safety and efficacy of dropping LDL cholesterol concentrations to very low levels with evolocumab.

In a secondary analysis of the FOURIER clinical trial, researchers considered the safety and efficacy of dropping LDL cholesterol concentrations to very low levels with evolocumab. The prespecified protocol included roughly 2 years of followup on FOURIER's nearly 26,000 participants who, after being treated with the monoclonal antibody evolocumab or with placebo, achieved LDL concentrations ranging from 2.6 mmol/L or higher to 0.5 mmol/L or lower at 4-week followup. A monotonic relationship was detected between low cholesterol levels and reduced risk for the primary endpoint—a composite of cardiovascular death, myocardial infarction, stroke, coronary revascularisation, or unstable angina—even for LDL concentrations of less than 0.2 mmol/L. The finding, and the fact that no safety concerns were raised during the follow-up period, offer support for the practice of reducing LDL cholesterol to well below currently recommended levels in patients with cardiovascular disease.