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Comment & Response
June 23, 2021

Myocardial Infarction and Evolocumab

Author Affiliations
  • 1Green Lane Cardiovascular Research Unit, Auckland City Hospital, Auckland, New Zealand
  • 2Assistance Publique–Hôpitaux de Paris, Hôpital Bichat, Université de Paris, Paris, France
  • 3Division of Cardiology, University of Colorado School of Medicine, Aurora
JAMA Cardiol. 2021;6(10):1220-1221. doi:10.1001/jamacardio.2021.1994

To the Editor In an analysis of the Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk (FOURIER) randomized clinical trial in patients with stable atherosclerotic disease receiving statin therapy, Wiviott et al1 report that the PCSK9 inhibitor evolocumab reduced type 1 (spontaneous) myocardial infarction (MI) by 32% (hazard ratio [HR], 0.68; 95% CI, 0.59-0.79) but had no effect on type 2 (supply/demand mismatch) MI (HR, 1.09; 95% CI, 0.82-1.45). The latter finding is contrary to previous observations from the Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab (ODYSSEY OUTCOMES) trial2 in patients with recent acute coronary syndrome receiving intensive statin therapy. In that analysis, the PCSK9 inhibitor alirocumab reduced type 2 MI by 23% (HR, 0.77; 95% CI, 0.61-0.97; P = .03).2

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