PCSK9 inhibition with evolocumab "significantly reduced the risk of cardiovascular events" in patients with peripheral artery disease (PAD), according to an analysis of the FOURIER trial presented Nov. 13 at AHA 2017 in Anaheim, CA, and simultaneously published in Circulation. A separate analysis also showed the benefit of evolocumab in patients with a history of myocardial infarction (MI).

Marc P. Bonaca, MD, MPH, looked at 3,642 patients with PAD in the FOURIER trial. Results showed that evolocumab significantly reduced the primary endpoint -- a composite of cardiovascular death, MI, stroke, hospital admission for unstable angina, or coronary revascularization -- in these patients. Further, evolocumab reduced the risk of major adverse limb events in all patients with "consistent effects in those with and without known PAD."

In a separate FOURIER trial analysis that looked at 22,351 patients with a history of MI, Marc S. Sabatine, MD, MPH, FACC, et al., found that patients closer to their most recent MI, with multiple prior MIs, or with residual multivessel coronary artery disease were at a 34-90 percent greater risk for major vascular events.

In addition, these patients experience "substantial relative risk reductions (21-30 percent) and absolute risk reductions (2.6-3.4 percent over three years) with intensive LDL-C lowering with the PCSK9 [inhibitor] evolocumab."

The researchers conclude that "a patient's history of coronary disease offers a way to tailor PCSK9 inhibitor use to maximize benefit."

Keywords: AHA17, AHA Annual Scientific Sessions, Peripheral Arterial Disease, Antibodies, Monoclonal, Hypercholesterolemia

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