Evolocumab following CABG did not reduce saphenous vein graft (SVG) disease rates at two years when compared with placebo, based on findings from the NEWTON-CABG CardioLink-5 trial presented at ESC Congress 2025 and simultaneously published in The Lancet.

Researchers randomized 782 individuals at 23 sites in Canada, the U.S., Australia, and Hungary (median age 66 years/15% female) to receive evolocumab (140 mg) or placebo every two weeks. All participants underwent CABG with at least two SVGs and were being treated with moderate or high intensity statin therapy.

Results showed a mean 48.4% placebo-adjusted reduction in LDL-C at 24 months in patients receiving evolocumab (–52% vs. –4%). The 24-month vein graft disease rate was 21.7% (149 of 686 grafts) in the evolocumab group compared with 19.7% (127 of 644 grafts) in the placebo group. In other findings, treatment was well tolerated, with similar adverse event profiles between the groups.

"Evolocumab substantially lowered LDL-C levels but did not reduce SVG disease rates at two years compared with placebo," said Subodh Verma, MD, PhD, in presenting the findings. "While PCSK9 inhibitors continue to play an important role in secondary prevention in these patients, our findings suggest that further LDL-C lowering does not affect the pathophysiological mechanisms of early graft failure. Rather, remodeling, thrombotic and/or inflammatory processes may be responsible, and further research is needed to develop novel approaches to reduce the current high rates of SVG disease."