FOURIER Trial Key Points:
- FOURIER trial established the role of PCSK9 inihibitor therapy in reducing future cardiovascular events and mortality.
- Evolocumab showed benefit in terms of cardiovascular disease but didn’t show any mortality benefit.
- These agents were utilized in patients who were already on moderate to high intensity statin therapy.
- PCSK9 inhibition was well-tolerated without excess new-onset diabetes or neurocognitive effects despite dramatic LDL reduction.
Guidelines on PCSK9 inhibition – ACC 2017 Update for Non-Statin Therapy
- If patients with clinical ASCVD and comorbidities require >25% additional lowering of LDL-C, a PCSK9 inhibitor may be preferred as the initial non-statin agent.
- If patients with clinical ASCVD and baseline LDL-C ≥190 mg/dL require >25% additional lowering of LDL-C or have additional comorbidities as defined in the previous text, a PCSK9 inhibitor may be preferred as the initial non-statin agent.
- If high-risk patients with baseline LDL-C ≥190 mg/dL require additional LDL-C lowering (<50% reduction in LDL-C, may consider LDL-C ≥100 mg/dL or
non–HDL-C ≥130 mg/dL) after the addition of a single non-statin agent (i.e., ezetimibe) to maximally tolerated statin therapy, it is reasonable to consider the addition of a second non-statin agent (i.e., ezetimibe plus PCSK9 inhibitor).
- Read full guidelines at ACC