Characteristics of Asians in the FOURIER Trial Using Evolocumab

Masaaki Miyata
2021 Circulation Journal  
statin therapy. It demonstrated that inhibition of PCSK9 with evolocumab, the monoclonal antibody for PCSK9, decreased LDL cholesterol levels from 92 mg/dL to 30 mg/dL and reduced the risk of cardiovascular events. 3 Because of differences in genetics, physical size, drug metabolism, usage of high-intensity statins, and incidence of CAD between Asians and other races, it is important to compare the effects and adverse events of evolocumab between Asians and others. In this issue of the Journal,
more » ... Keech et al evaluate the efficacy and safety of evolocumab among Asians vs. other subjects using data from the FOURIER trial, and conclude that the use of evolocumab robustly lowers LDL-cholesterol and is equally safe and efficacious T he first epoch-making discovery in lipid-lowering medicine for hypercholesterolemia was identification of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase (i.e., statin) by Dr. Akira Endo, and the second one was the proprotein convertase subtilisin kexin 9 (PCSK9) antibody inhibitor. PCSK9 is a member of the subtilisin serine protease family and plays a role in the degradation of the low-density lipoprotein (LDL) receptor. 1 Loss-of-function variants in the PCSK9 gene are associated with the reduction in LDL-cholesterol and overall coronary artery disease (CAD). 2 The Further Cardiovascular Outcomes Research with PCSK9 Inhibition in Subjects with Elevated Risk (FOURIER) trial was a randomized, double-blind, placebo-controlled trial involving 27,564 patients with atherosclerotic cardiovascular disease and LDL-cholesterol levels of ≥70 mg/dL who were receiving Figure. Comparison of least-squares mean percentage change in lipid by Asians vs. others. Least-squares mean (adjusted mean) is based on a repeated measures ANCOVA model including treatment, randomization strata (LDL ≥85 mg/dL and region), visit and the interaction of treatment-by-visit interaction with the baseline value. Least-squares mean percent change shows the treatment difference between evolocumab and placebo groups. HDL, high-density lipoprotein; LDL, low-density lipoprotein. (Figure created using the data of Keech et al 4 with permission.)
doi:10.1253/circj.cj-21-0246 pmid:33980783 fatcat:75xvrtb34fgwvoelgbcpl7m3za