Anthony C Keech1, Kazuma Oyama2,3, Peter S Sever4, Minao Tang2, Sabina A Murphy2, Atsushi Hirayama5, Chen Lu6, Leslie Tay7, Prakash C Deedwania8, Chung-Wah Siu9, Armando Lira Pineda6, Donghoon Choi10, Min-Ji Charng11,12, John Amerena13, Wan Azman Wan Ahmad14, Vijay K Chopra15, Terje R Pedersen16, Robert P Giugliano2, Marc S Sabatine2. 1. National Health and Medical Research Council Clinical Trials Centre, Sydney Medical School, University of Sydney. 2. TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School. 3. Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine. 4. International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London. 5. Division of Cardiology, Department of Medicine, Nihon University School of Medicine. 6. Amgen. 7. Cardiology Department, Changi General Hospital. 8. University of California San Francisco School of Medicine. 9. Cardiology Division, Department of Medicine, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong SAR. 10. Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine. 11. Division of Cardiology, Taipei Veterans General Hospital. 12. Faculty of Medicine, School of Medicine, National Yang Ming University. 13. Geelong Cardiology Research Unit, Barwon Health. 14. Cardiology Department, University Malaya Medical Center. 15. Department of Cardiology, Max Super Speciality Hospital. 16. Medical Faculty, Oslo University Hospital Aker.
Abstract
BACKGROUND: There are concerns that Asian patients respond differently to some medications. This study evaluated the efficacy and safety of evolocumab among Asian vs. other subjects in the FOURIER trial, which randomized stable atherosclerosis patients to receive either evolocumab or placebo.Methods and Results: Effects of adding evolocumab vs. placebo to background statin therapy on low-density lipoprotein cholesterol (LDL-C) reductions, cardiovascular outcomes, and adverse events were compared among 27,564 participants with atherosclerotic disease, according to self-reported Asian (n=2,723) vs. other (n=24,841) races followed for a median of 2.2 years in the FOURIER trial. The primary endpoint was a composite of cardiovascular death, myocardial infarction, stroke, hospitalization for unstable angina, or coronary revascularization. At randomization, Asians had slightly lower LDL-C (median 89 [IQR 78-104] mg/dL vs. 92 [80-109] mg/dL; P<0.001) and were much less likely to be on a high-intensity statin (33.3% vs. 73.3%; P<0.001). Evolocumab lowered LDL-C more in Asians than in others (66% vs. 58%; P<0.001). The effect of evolocumab on the primary endpoint was similar in Asians (HR, 0.79; 95% CI, 0.61-1.03) and others (HR, 0.86; 95% CI, 0.79-0.93; P interaction=0.55). There was no excess of serious adverse events with evolocumab among Asians over others. CONCLUSIONS: Use of evolocumab robustly lowers LDL-C and is equally efficacious in lowering the risk of cardiovascular events and safe in Asians as it is in others.
BACKGROUND: There are concerns that Asian patients respond differently to some medications. This study evaluated the efficacy and safety of evolocumab among Asian vs. other subjects in the FOURIER trial, which randomized stable atherosclerosis patients to receive either evolocumab or placebo.Methods and Results: Effects of adding evolocumab vs. placebo to background statin therapy on low-density lipoprotein cholesterol (LDL-C) reductions, cardiovascular outcomes, and adverse events were compared among 27,564 participants with atherosclerotic disease, according to self-reported Asian (n=2,723) vs. other (n=24,841) races followed for a median of 2.2 years in the FOURIER trial. The primary endpoint was a composite of cardiovascular death, myocardial infarction, stroke, hospitalization for unstable angina, or coronary revascularization. At randomization, Asians had slightly lower LDL-C (median 89 [IQR 78-104] mg/dL vs. 92 [80-109] mg/dL; P<0.001) and were much less likely to be on a high-intensity statin (33.3% vs. 73.3%; P<0.001). Evolocumab lowered LDL-C more in Asians than in others (66% vs. 58%; P<0.001). The effect of evolocumab on the primary endpoint was similar in Asians (HR, 0.79; 95% CI, 0.61-1.03) and others (HR, 0.86; 95% CI, 0.79-0.93; P interaction=0.55). There was no excess of serious adverse events with evolocumab among Asians over others. CONCLUSIONS: Use of evolocumab robustly lowers LDL-C and is equally efficacious in lowering the risk of cardiovascular events and safe in Asians as it is in others.
Authors: Juan Tamargo; Juan Carlos Kaski; Takeshi Kimura; Jack Charles Barton; Ko Yamamoto; Maki Komiyama; Heinz Drexel; Basil S Lewis; Stefan Agewall; Koji Hasegawa Journal: Eur Heart J Cardiovasc Pharmacother Date: 2022-09-29