Adding evolocumab to statin therapy may significantly reduce the risk of developing complex coronary disease requiring revascularization, including complex PCI and CABG individually, according to a study published Jan. 18 in the Journal of the American College of Cardiology.

Using data from the FOURIER trial, Kazuma Oyama, MD, PhD, et al., assessed 1,724 patients who underwent coronary revascularization, including 1,482 who underwent PCI, 296 who underwent CABG and 54 who underwent both. Complex revascularization was performed in 632 (37%) patients.

Results showed that evolocumab reduced the risk of any coronary revascularization by 22%, simple PCI by 22%, complex PCI by 33%, CABG by 24% and complex revascularization by 29%.

Furthermore, the authors found that the magnitude of the risk reduction with evolocumab in complex revascularization tended to increase over time (20%, 36% and 41% risk reductions in the first, second and beyond second years, respectively).

"Together with prior coronary imaging findings, these data suggest that very aggressive LDL-C lowering may have beneficial effects on coronary atherosclerosis burden, anatomic complexity and need for coronary revascularization," the authors conclude.

In a related editorial comment, E. Magnus Ohman, MD, FACC, and Michael G. Nanna, MD, MHS, FACC, note that "we may have finally married aggressive lipid-lowering management with revascularization, where LDL-C <70 mg/dl should be considered the 'norm' as soon as possible after the onset of [acute coronary syndrome]." They add that, "the time has come for patients, surgeons and interventional cardiologists to come to harmony with the notion that lower is better for both prevention and revascularization."

Clinical Topics: Acute Coronary Syndromes, Cardiac Surgery, Dyslipidemia, Invasive Cardiovascular Angiography and Intervention, Atherosclerotic Disease (CAD/PAD), Aortic Surgery, Lipid Metabolism, Nonstatins, Novel Agents, Statins, Interventions and ACS, Interventions and Coronary Artery Disease

Keywords: Cholesterol, LDL, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Coronary Artery Disease, Acute Coronary Syndrome, Percutaneous Coronary Intervention, Coronary Artery Bypass, Risk Reduction Behavior, Surgeons

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