FOURIER study : we have to treat the LDL target

10 april 2017

The FOURIER study has finally revealed its results !

The study yielded the positive result that the antibody PCSK9 evolocumab (Repatha®, Amgen), administered alongside a statin against the placebo, significantly lowered the primary criterion, which was a composite of cardiovascular events (cardiovascular mortality, non-fatal myocardial infarctions and strokes, coronary revascularisation and unstable angina), by 15%, after an average monitoring duration of 26 months. A significant reduction of 20% was observed in the secondary composite criterion of 3 points (cardiovascular mortality, non-fatal myocardial infarctions and strokes), of 27% in myocardial infarctions and 20% in ischemic strokes, but no trend was observed in the reduction of cardiovascular mortality or of an overall reduction.

FOURIER, multinational study (49 countries, 1242 sites), randomised, double-blind carried out on 27764 subjects with a proven atherosclerotic illness (history of myocardial infarction, stroke, PAD), and aged 40 to 85 years (75% male) and already on statins. It included two “active” groups receiving different doses of evolocumab: 140 mg 1/15 days or 420 mg 1/month and a placebo group.

FOURIER has confirmed LDL causality (we no longer refer to LDL hypothesis!). The only downside is that the study was not long enough (? 2 years), which explains the lack of benefit for cardiovascular mortality. We should also note that lowering LDL-cholesterol on average to 0.30 mg/dL (a level not achieved so far) is both beneficial on a cardiovascular level and also well-tolerated.

Given the current controversies, these results clearly confirm the “LDL target” and the absolute necessity to treat hypercholesterolemia.

More info  : Sabatine MS, & al. N Engl J Med. 2017 Mar 17 and Diapos de présentation des résultats to the American College of Cardiology congress 2017.