Evolocumab and clinical outcomes in patients with cardiovascular disease

ischaemic heart disease remains the leading cause of death worldwide. 1 decades of research have established that the accumulation of the cholesterol cargo carried by low density lipoprotein particles within the arterial wall is the initiating factor in atherogenesis and its clinical manifestation as coronary artery disease. large scale epidemiological studies, mendelian randomisation genetic studies and trials of therapeutic interventions have established that low density lipoprotein cholesterol (ldl-C) is a causal factor in developing atherosclerotic heart disease. 2–5 the mainstay of therapy for reducing ldl-C has so far been with statin therapy initially followed by add-on therapy. despite current lipid lowering therapies, a proportion of patients either fail to reach their target ldl-C with statins or are intolerant to statins thus limiting treatment options. While ezetimibe can be used as an add-on or alternative to statins, the modest 20% reduction in ldl-C precludes more widespread use. there is therefore, an unmet need for further ldl-C reduction with new treatments, among those with high atherosclerotic cardiovascular disease risk such as those with prevalent disease or with familial hypercholesterolaemia.