To evaluate the effect of proprotein convertase subtilisin/kexin type 9 inhibition with evolocumab on major cardiovascular events in patients with diabetes without known significant atherosclerosis.
Key Findings:
Evolocumab reduced the incidence of major cardiovascular events: 5% in the evolocumab group vs 7% in the placebo group.
Significant reductions in secondary outcomes: 34% reduction in myocardial infarction, ischemic stroke, or revascularization.
Cardiovascular death rates were 2% for evolocumab vs 3% for placebo; all-cause mortality was 7% vs 10%.
Interpretation:
Lowering LDL-C levels with evolocumab significantly reduced cardiovascular event risks in high-risk diabetic patients, supporting lower LDL-C goals in primary prevention.
Limitations:
Imaging for atherosclerosis was not performed in all patients, possibly missing unrecognized disease.
Study population was predominantly White, limiting generalizability.
Results are from a subgroup analysis and require confirmation in larger prospective studies.
Conclusion:
Evolocumab effectively lowers LDL-C and reduces cardiovascular events in high-risk diabetes patients, suggesting a single LDL-C target for all high-risk individuals.
